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Nursing Pharmacology Prelim

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Nursing Pharmacology Prelim

  1. 1. NURSING PHARMACOLOGY
  2. 2. I. Fundamentals of Pharmacology <ul><li>Pharmacology </li></ul><ul><li>Study of the biological effects of chemicals. </li></ul><ul><li>Drugs </li></ul><ul><li>Chemicals that are introduced in the body to cause some sort of change. </li></ul><ul><li>Pharmacokinetics </li></ul><ul><ul><ul><li>Absorption, distribution, metabolism, and </li></ul></ul></ul><ul><ul><ul><li>excretion of drug(s) in the body. </li></ul></ul></ul>
  3. 3. <ul><li>Pharmacotherapeutics </li></ul><ul><ul><ul><li>The use of drugs to prevent or treat a disease. </li></ul></ul></ul><ul><li>Pharmacodynamics </li></ul><ul><ul><ul><li>The biochemical and physical effect of drug(s) and the mechanism of drug action. </li></ul></ul></ul>
  4. 4. pharmacokinetics pharmacotherapeutics pharmacodynamics pharmacology
  5. 5. Sources: <ul><li>Plants </li></ul><ul><ul><ul><li>Earliest drug source (leaves, roots, bulbs, fruits, blossoms, extracts) </li></ul></ul></ul><ul><ul><ul><li>Ex. Alkaloids – most active component in plants, reacts with acids to form a salt that easily dissolves in body fluids (caffeine, Nicotine, Atropine) </li></ul></ul></ul><ul><ul><ul><li> Glycosides – naturally occurring plant active components that has both toxic and good effect (lanoxin, digoxin) </li></ul></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
  6. 6. <ul><ul><ul><li>Resins – local irritants and caustic agents (laxatives) </li></ul></ul></ul><ul><ul><ul><li>Oils – thick greasy liquids volatile:( peppermint, spearmint, juniper)/ fixed:( castor oil, olive oil) </li></ul></ul></ul><ul><li>Animals </li></ul><ul><ul><ul><li>Body fluids, glands of animals are also natural drug source </li></ul></ul></ul><ul><ul><ul><li>Ex. Hormones – (insulin) </li></ul></ul></ul><ul><ul><ul><li>Oils & Fats – (liver oils) </li></ul></ul></ul><ul><ul><ul><li>Enzymes – catalyst produced by living cells (pepsin) </li></ul></ul></ul><ul><ul><ul><li>Vaccines – suspension of killed, modified, or attenuated microorganism </li></ul></ul></ul>
  7. 7. <ul><li>Minerals </li></ul><ul><ul><ul><li>Metallic and non metallic minerals that provides inorganic materials not available in plants or animals. </li></ul></ul></ul><ul><ul><ul><li>Usually combined with other ingredients </li></ul></ul></ul><ul><ul><ul><li>Ex. ( Fe S04, Mg SO4, ) </li></ul></ul></ul><ul><li>Nursing Responsibilities </li></ul><ul><li>Administer drug by using 10 R’s </li></ul><ul><li>Assessing drug effects </li></ul><ul><li>Intervening to make the drug treatment more tolerable </li></ul><ul><li>Health teaching abt. The drug </li></ul><ul><li>Monitoring overall px care plan to prevent medication error </li></ul>
  8. 8. Legal/Ethical Considerations <ul><li>Control of Drug Development, </li></ul><ul><li>Evaluation {Pre clinical trials} {Phases of Drug studies I - IV} {Approval} {Continual Evaluation} </li></ul><ul><li>Pregnancy Category {A – X} </li></ul><ul><li>Production {Controlled Substance, Generic Drugs, Orphan Drugs,} </li></ul><ul><li>Dispensing {OTC Drugs, Generic Drugs, DAW Drugs} </li></ul>
  9. 9. R’s of Drug Administration <ul><li>Right drug and patient </li></ul><ul><li>Right storage of drug </li></ul><ul><li>Right route </li></ul><ul><li>Right dosage </li></ul><ul><li>Right preparation </li></ul><ul><li>Right timing </li></ul><ul><li>Right recording/ documentation </li></ul><ul><li>Take complete px drug hx </li></ul><ul><li>Know if px has any drug allergies </li></ul><ul><li>Be aware of potential drug – drug or drug – food interactions </li></ul><ul><li>Teach your px about the drug he is receiving </li></ul>
  10. 10. Routes / Sites of Administration <ul><li>Enteral: </li></ul><ul><ul><li>Oral </li></ul></ul><ul><ul><ul><li>Solid </li></ul></ul></ul><ul><ul><ul><li>Liquid </li></ul></ul></ul><ul><ul><ul><li>Meds by NGT </li></ul></ul></ul><ul><ul><ul><li>Enteral feedings </li></ul></ul></ul><ul><li>Rectal </li></ul><ul><li>Disposable Enemas </li></ul>
  11. 11. <ul><li>Parenteral </li></ul><ul><ul><li>Intradermal </li></ul></ul><ul><ul><li>Subcutaneous </li></ul></ul><ul><ul><li>Intramuscular </li></ul></ul><ul><ul><li>Intravenous </li></ul></ul><ul><li>Percutaneous </li></ul><ul><ul><li>Topical </li></ul></ul><ul><ul><ul><li>Creams, lotion, ointments </li></ul></ul></ul><ul><ul><ul><li>Patch testing for allergies </li></ul></ul></ul><ul><ul><ul><li>NTG (Transdermal) </li></ul></ul></ul><ul><ul><ul><li>Medication to Mucus membranes </li></ul></ul></ul><ul><ul><ul><li>Topical powder </li></ul></ul></ul>
  12. 12. <ul><li>PHARMACODYNAMICS - how the drug affects the body </li></ul><ul><li>DRUG ACTIONS: </li></ul><ul><li>To replace or acts as a substitute for missing chemicals. </li></ul><ul><li>Increase or stimulate certain cellular activities. </li></ul><ul><li>To decrease or slow cellular activities. </li></ul><ul><li>To interfere with the functioning of foreign cells such as invading microorganism or neoplasm </li></ul>
  13. 13. <ul><li>Receptor Sites – specified areas in the cell that allows certain chemicals to cause an effect in the cell </li></ul><ul><li>AGONIST – direct interaction of drug that causes same activity (Ex. Insulin-Insulin Receptor) </li></ul><ul><li>ANTAGONIST – has an affinity for a receptor but displays no intrinsic activity </li></ul><ul><ul><ul><ul><ul><li>Prevents a response from occurring </li></ul></ul></ul></ul></ul>
  14. 14. <ul><li>COMPETITIVE ANTAGONIST - competes c agonist for receptor sites Ex. (Curare vs. acethylcholine receptor sites) </li></ul><ul><li>NON COMPETITIVE – binds to receptor sites & blocks the effect of the agonist (protects / prevent another antagonist from entering) </li></ul><ul><li>DRUG ENZYME INTERACTIONS – drug effects by interfering c enzyme system that acts as a CATALYST for various chemical reactions </li></ul><ul><ul><ul><ul><ul><li>blocks the cascade effect of enzyme </li></ul></ul></ul></ul></ul><ul><li>SELECTIVE TOXICITY – choosy? Ex. (penicillin attacks enzyme system unique to bacterial cell death) </li></ul><ul><li>NON SELECTIVE TOXICITY – not so choosy? Ex. (chemotherapeutic drugs destroying normal & neoplastic cells) </li></ul>
  15. 15. <ul><li>PHARMACOKINETICS – how the body acts on the drug </li></ul><ul><ul><li>CRITICAL CONCENTRATION – sufficient / high concentration of the administered drug working at the (molecular level ) reactive tissues </li></ul></ul><ul><ul><li>DOSAGE – based on the amount that must be given to eventually reach the critical concentration </li></ul></ul><ul><ul><li>LOADING DOSE – usually drugs that are needed to take effect quickly Ex. (Aminophylline, Lanoxin) </li></ul></ul><ul><ul><li>DYNAMIC EQUILIBRIUM – actual concentration that a drug reaches the body </li></ul></ul><ul><ul><ul><li>FACTORS: </li></ul></ul></ul><ul><ul><ul><ul><li>ABSORPTION FROM THE SITE OF ENTRY </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DISTRIBUTION ON THE ACTIVE SITE </li></ul></ul></ul></ul><ul><ul><ul><ul><li>BIOTRANSFORMATION IN THE LIVER </li></ul></ul></ul></ul><ul><ul><ul><ul><li>EXCRETION FROM THE BODY </li></ul></ul></ul></ul>
  16. 16. <ul><li>ABSORPTION- what happens to a drug from the time it is introduced to the body until it reaches the circulating fluids and tissues. </li></ul><ul><li>Areas of Absorption: </li></ul><ul><li>GI, Orally, Rectally, Skin, Mucus Membranes, Lungs, Muscles, Subcutaneous </li></ul><ul><li>How Drugs are absorbed: </li></ul><ul><li>☺ Passive Diffusion- Major process of absorption </li></ul><ul><ul><li>- when there is ↑concentration in one side, drug molecules moves towards the area of ↓concentration </li></ul></ul>
  17. 17. <ul><ul><li>- movement towards the other side is faster if the molecules are smaller, soluble in water and lipid </li></ul></ul><ul><ul><li>- no electrical charge that could repel it from the cell membrane </li></ul></ul><ul><ul><li>Effortless process, passive process. </li></ul></ul><ul><ul><li>Most common in oral form of medication. </li></ul></ul><ul><li>☻ Active Transport – uses energy to actively move a molecule across a cell membrane </li></ul><ul><ul><li>- Molecule moves from an area of ↓ concentration to area of ↑concentration (usu. electrolytes) </li></ul></ul>
  18. 18. <ul><li>☻ ADMINISTRATION & ABSORPTION ☺ </li></ul><ul><li>Ж ORAL – most common, non invasive, practical & viable </li></ul><ul><ul><ul><ul><li>easily broken down by the gastric juices </li></ul></ul></ul></ul><ul><ul><ul><ul><li>affected by presence or absence of food in the stomach </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Ideal timing for administration ( ? ) </li></ul></ul></ul></ul><ul><li>Ψ INTRAVENOUS – drugs that cannot survive in enough quantity hen given orally </li></ul><ul><ul><ul><ul><li>- Reaches their full strength @ the time of injection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>More like ly to cause toxic effect (↑ margin for error ) </li></ul></ul></ul></ul><ul><li>Ω INTRAMUSCULAR – absorbed directly in the capillaries in the muscles & sent into circulation (1-5cc) (site of giving?) </li></ul><ul><ul><ul><ul><li>- Takes effect faster in men than in women ( Tº? ) </li></ul></ul></ul></ul>
  19. 19. <ul><li>Ф SUBCUTANEOUS –small amt(0.5 – 1cc)usually in the upper arm, abdomen, thigh </li></ul><ul><ul><ul><ul><li>- drugs move rapidly in vessels than in oral </li></ul></ul></ul></ul><ul><li>ß RECTAL / VAGINAL – absorbed by the perfusion of local blood flow in the rectum/ vagina </li></ul><ul><ul><ul><ul><li>- treatment of local irritation or infection </li></ul></ul></ul></ul><ul><li>Ξ RESPIRATORY – available in all forms that targets the lungs </li></ul><ul><ul><ul><ul><li>- mostly in gas or inhalation form or mist </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- (ET route?) </li></ul></ul></ul></ul><ul><li>₤ BUCCAL/SUB LINGUAL & TRANSLINGUAL – common route for certain cases of emergency </li></ul><ul><ul><ul><ul><li>- drugs prevent destruction/transformation in the GI </li></ul></ul></ul></ul>
  20. 20. <ul><li> TOPICAL – superficial or external use only </li></ul><ul><ul><ul><li>- used for dermatologic, ophthalmic, otic and nasal preparation </li></ul></ul></ul><ul><li>♣ SPECIAL AREAS / INFUSIONS – given to a specific area of the body </li></ul><ul><li>Epidural – injected in epidural space </li></ul><ul><li>Intrapleural – injected in the pleural cavity </li></ul><ul><li>Intraperitoneal – injected in the peritoneal cavity </li></ul><ul><li>Intraosseus – injected in the rich vascular bone network(long bone) </li></ul><ul><li>Intra-articular – injected into a joint </li></ul>
  21. 21. <ul><li>FIRST PASS EFFECT – liver synthesizes and breakdown much of the component thereby needing a ↑ dose to have a desired effect </li></ul><ul><ul><ul><ul><li>- ◙ drug -> stomach -> small intestine -> portal venous system (liver)-> heart(® side) -> heart (left side)-> systemic circulation-> area (affected) in need of </li></ul></ul></ul></ul><ul><ul><ul><ul><li>drug ☼ </li></ul></ul></ul></ul><ul><li>THINGS to consider in first pass effect </li></ul><ul><ul><li>Px diet / food preference </li></ul></ul><ul><ul><li>Drug preparation / formulations </li></ul></ul><ul><ul><li>Liver affectation </li></ul></ul>
  22. 22. <ul><li>DISTRIBUTION – movement of the drugs that survived the first pass effect thru the body tissues </li></ul><ul><li>FACTORS: </li></ul><ul><li>BLOOD FLOW - ↑ blood flow ↑distribution & absorption </li></ul><ul><li>SOLLUBILITY – fat soluble (easily crosses cell membrane, can cross BBB CNS) or H²O soluble </li></ul><ul><li>BINDING – drugs bind c plasma protein (albumin) </li></ul><ul><ul><li>FREE / UNBOUNDED – exerts effectiveness, excreted quickly </li></ul></ul><ul><ul><li>BOUNDED – slow release, long duration of action, hard to dispose </li></ul></ul>
  23. 23. <ul><li>METABOLISM / BIOTRANSFORMATION – Conversion of drugs by the ◙ LIVER☼ thru the use of bodily system, enzymes </li></ul><ul><ul><ul><ul><li>Ability of the body to change a drug from its dosage form to a more water soluble form </li></ul></ul></ul></ul><ul><li>► EXCRETION – Elimination of drugs from the body (kidneys, lungs, skin, salivary, mammary glands, GI tract) </li></ul><ul><li>♥ ½ LIFE♦ - The time it takes for the amt. of drug in the body to ↓ to ½ of the peak level it previously achieved </li></ul><ul><ul><ul><ul><ul><li>- time it takes for ½ of the drug to be excreted by the body </li></ul></ul></ul></ul></ul>
  24. 24. <ul><li>Factors: </li></ul><ul><ul><li>Rate of absorption </li></ul></ul><ul><ul><li>Metabolism </li></ul></ul><ul><ul><li>Appropriate dose </li></ul></ul><ul><ul><li>Excretion </li></ul></ul><ul><li>Variables Influencing Drug Action </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><li>Physiological </li></ul></ul><ul><ul><li>Pathological </li></ul></ul><ul><ul><li>CV </li></ul></ul><ul><ul><li>Liver / Kidney dse. </li></ul></ul><ul><ul><li>Genetic </li></ul></ul><ul><ul><li>Psychological </li></ul></ul><ul><ul><li>Environmental </li></ul></ul>
  25. 25. <ul><li>TOLERANCE - ↑ Resistance to a drug effect 2° to ↑ biotransformation of drug components. </li></ul><ul><li>DEPENDENCE – may come about if px manifest withdrawal S/Sx when drug is stopped. </li></ul><ul><li>DRUG – DRUG INTERACTION </li></ul><ul><ul><li>SITUATIONS: </li></ul></ul><ul><ul><li>At the site of absorption (tetracycline vs. Ca & Ca products*) </li></ul></ul><ul><ul><li>During distribution (ASA* vs. methotrexate) </li></ul></ul><ul><ul><li>During metabolism (coumadin* vs. anti tb) </li></ul></ul><ul><ul><li>During excretion (Lanoxin vs. Quinidine*) </li></ul></ul><ul><ul><li>At the site of action (Anti HPN vs. AH’s*) </li></ul></ul>
  26. 26. <ul><li>DRUG TO FOOD INTERACTIONS : SOME FOODS AFFECTS DRUG FUNCTION AND EFFICIENCY </li></ul><ul><ul><li>TETRACYCLINES vs. Fe / Ca </li></ul></ul><ul><li>DRUG TO LAB TEST : GIVING DRUGS PRIOR TO A LAB TEST CAN ALTER THE RESULT </li></ul><ul><ul><li>ATB prior to sputum/ wound GS/ CS </li></ul></ul><ul><ul><li>Anti DVT (Fragmin) alters (↑) liver fxn test exams </li></ul></ul>
  27. 27. <ul><li>PHARMACOTHERAPEUTICS – USE OF DRUG TO TREAT/ CURE A DISEASE </li></ul><ul><ul><li>ACUTE – CRITICALLY ILL Px THAT REQUIRES INTENSIVE THERAPY Ex.(Thrombolytics for AMI px) </li></ul></ul><ul><ul><li>EMPERICAL – BASE ON PRACTICAL EXPERINCE RATHER THAN SCIENTIFIC DATA Ex.( EMPERIC ATB prior to GS / CS) </li></ul></ul><ul><ul><li>SUPPLEMENTAL – REPLENISH / SUBSTITUTE FOR MISSING SUBSTANCE IN THE BODY Ex. (Ca for Osteoporotic px. Vit. B complex for DM px) </li></ul></ul><ul><ul><li>SUPPORTIVE – DOES NOT TREAT THE CAUSE OF THE DISEASE BUT MAINTAINS OTHER BODY SYSTEMS INTEGRITY UNTIL Px CONDITION IMPROVES Ex. ( O² in a PTB px) </li></ul></ul><ul><ul><li>PALLIATIVE – FOR END STAGE / TERMINAL Dse. PROMOTION OF COMFORT IS TOP PRIORITY Ex. (Bone CA px having continous M SO4 drip) </li></ul></ul>
  28. 28. <ul><li>ADVERSE EFFECTS – HARMFUL / UNDESIRABLE EFFECTS THAN HAT HAS BEEN EXPECTED OF A DRUG </li></ul><ul><ul><li>KINDS: </li></ul></ul><ul><ul><ul><li>DOSE RELATED ? </li></ul></ul></ul><ul><ul><ul><li>Px RELATED ? </li></ul></ul></ul><ul><li>DRUG ACTIONS: </li></ul><ul><ul><li>Primary – can be caused by simple overdose Ex. (overdose of blood thinners can lead to profuse bleeding) </li></ul></ul><ul><ul><li>Secondary – good or bad effect Ex. (AH’s can promote sleeping but what if the px will drive a vehicle) </li></ul></ul><ul><ul><li>Hypersensitivity - ↑ response to 1° / 2° drug actions that can lead to a pathological condition </li></ul></ul>
  29. 29. <ul><li>DRUG ALLERGY – Occurs when the body forms an antibodies to a particular drug causing an immune response upon re- exposure </li></ul><ul><ul><li>TYPES </li></ul></ul><ul><ul><ul><li>ANAPHYLACTIC – </li></ul></ul></ul><ul><ul><ul><li>CYTOTOXIC </li></ul></ul></ul><ul><ul><ul><li>SERUM SICKNESS </li></ul></ul></ul><ul><ul><ul><li>DELAYED RESPONSE </li></ul></ul></ul><ul><li>IDIOSYNCRATIC EFFECT – Non pharma related but can be genetic in origin </li></ul><ul><li>IATROGENIC EFFECT – Adverse drug reaction that tends to mimic a pathology Ex. (ASA cause GI irritation that mimics PUD) </li></ul>
  30. 30. Nursing process Asssessment Nursing Dx Planning Intervention Evaluation
  31. 31. <ul><ul><li>DERMATOLOGICAL </li></ul></ul><ul><ul><li>RASH / HIVES - Assessment: color, turgor, pattern & other pertinent data Intervention: frequent skin care, avoid friction, rubbing, and tight clothing, hydration </li></ul></ul><ul><ul><li>STOMATITIS – Assessment: observe for gingivitis, glositis, odinophagia, halitosis Intervention: frequent, proper oral care a non irritating solution, evaluate diet tolerance </li></ul></ul><ul><ul><li>SUPER INFECTION – Assessment: S/Sx on infection(fever, diarrhea, itching, redness, pain, warmth, discharge Intervention: proper body hygiene (bathing, hand washing etc.,) DC causative meds. </li></ul></ul><ul><ul><li>BLOOD DYSCRASIA – Assessment: fever, chills, ↓Hct /Hgb (Anemia), ↓Platelet count (thrombocytopenia), ↓ WBC (leukopenia), ↓CBC (pancytopenia) Intervention: supportive tx, prevent injury, monitor all lab exam / result </li></ul></ul>
  32. 32. <ul><li>TOXICITY </li></ul><ul><ul><li>LIVER TOXICITY – Assessment: fever, malaise, N & V, jaundice, stool change, altered LOC, ↑ liver enzyme lab results Intervention: hygiene, frequent rest periods, DC causative drugs, monitor for bleeding and altered LOC. </li></ul></ul><ul><ul><li>RENAL TOXICITY – Assessment: URINE (color, character, amount) monitor BUN, CREA level, edema Intervention: Strict / accurate I & O ( q 1 – q shift – q 24°), DC causative meds  (gentamycin, ampothericin B) </li></ul></ul><ul><li>POISONING – Occurs hen an overdose of drugs affects multiple body systems c possible or potential fatal reactions. </li></ul>
  33. 33. <ul><li>ALTERATIONS IN GLUCOSE METABOLISM </li></ul><ul><li>Hypoglycemia- OHA, Insulin </li></ul><ul><li>Assessment: S/Sx: fatigue, drowsiness, hunger, , anxiety, headache, cold clammy skin, shaking and lack of coordination, ↑HR, ↑BP, numbness and tingling of mouth, tongue and lips, confusion, rapid shallow respiration, seizure and coma </li></ul><ul><li>Interventions: Give hyperglycemic agents IV or Oral to prevent injury and falls </li></ul>
  34. 34. <ul><li>Hyperglycemia: Ex. (Ephedrine- bronchodilator/ Anti asthma that relieves nasal congestion causes ↑glucogenolysis </li></ul><ul><li>Assessment: fatigue, polyuria, ↑thirst (polydipsia), deep respirations (kausmauls), restlessness, polyphagia, nausea, dry flushed skin, fruity odor breath </li></ul><ul><li>Intervention: Insulin, OHA </li></ul>
  35. 35. ELECTROLYTE IMBALANCE <ul><li>Hypokalemia- drug affects kidneys can cause ↓ K level in serum by altering renal exchange system (proximal tubules) </li></ul><ul><li>Assessment: weakness, numbness, muscles cramps, nausea and vomiting, ↓bowel sounds, Hypokalemic paralysis </li></ul><ul><li>Interventions: K rich diet (unless CIx, K supplements prevent injury or falls) </li></ul>
  36. 36. <ul><li>HYPERKALEMIA - ↑K supplements, ↑K sparing diuretics, ↑K rich diets in renal problems </li></ul><ul><li>Assessment: weakness, DOB, bradycardia, Ms cramps, Numbness </li></ul><ul><li>Intervention: Monitor px status (CV,LOC, Homeostasis) diet modification, K wasting drug regimens / protocols, monitor lab exams. </li></ul>
  37. 37. <ul><li>SENSORY EFFECTS </li></ul><ul><ul><li>OCCULAR TOXICITY – Tiny blood vessels in the retina “END ARTERIES” are affected, occluded by some drugs Ex. ( Chloroquine) Aralen causes inflamation, retinal damage, blindness </li></ul></ul><ul><li>ASSESSMENT: observe for visual acquity, color or vision changes, corneal, retinal affectation </li></ul><ul><li>INTERVENTION: supportive tx, prevent injury, optic care – hygiene, proper drug administration </li></ul>
  38. 38. <ul><ul><li>AUDITORY TOXICITY : Tiny vessels & nerves can be affected by some drug hearing affectation / disturbance Ex. (ASA can cause tinnitus or aural fullness hen given in excessive doses) </li></ul></ul><ul><ul><li>ASSESSMENT: hearing acquity, Rine’s test, Rombergs test, </li></ul></ul><ul><ul><li>INTERVENTION: Prevent injury, monitor for perceptual losses, symptomatic drug treatment, (speak in medium tone firm voice) </li></ul></ul>
  39. 39. Nursing process Eval Intervention/ Implementation Planning Nsg Dx Assessment
  40. 40. <ul><li>Common household measurements: </li></ul><ul><li>1quart= 4 cups 1pint = 2 cups </li></ul><ul><li>1cup= 8 ounces 1tbsp= 3tsp: 15 – 16 ml </li></ul><ul><li>1tsp = 60ugtts: 4-5ml </li></ul><ul><li>Apothecary Measurements: </li></ul><ul><li>60minims = 1fluidram 8fluidram=1fl oz; 480minims 16 fl oz =1 pint 2pints=1quart </li></ul><ul><li>4quarts = 1gallon </li></ul>
  41. 41. <ul><li>Metric measurements: </li></ul><ul><li>Units of length (meter) </li></ul><ul><li>1mm = .001m 1cm = .01m </li></ul><ul><li>1hectometer = 100 meters </li></ul><ul><li>Units of volume (liter) </li></ul><ul><li>1ml = .001L 1decaliter = 10 Liters </li></ul><ul><li>Units of wt (gram) </li></ul><ul><li>1ug/mcg = .00001gm 1mg = .001gm </li></ul><ul><li>1cg = .01gm 1dg = .1gm </li></ul><ul><li>1dg = .1gm 1kg = 1,000grams </li></ul>
  42. 42. <ul><li>Other unit equivalents </li></ul><ul><li>1gm = 15 gr. 1gr. = 60mg </li></ul><ul><li>1mg = 1oooug </li></ul><ul><li>1ml =1cc;15gtts;60ugtts;1gram </li></ul><ul><li>1L = 1qt;1000ml </li></ul><ul><li>1gal = 4L; 4qt; 4000cc </li></ul><ul><li>1oz = 30gm;30cc </li></ul><ul><li>1kg = 2.2lbs </li></ul><ul><li>1lb = 16 oz </li></ul>
  43. 43. <ul><li>Drug computations </li></ul><ul><li>Formulas: </li></ul><ul><ul><li>VOL. OF DRUG TO BE GIVEN: </li></ul></ul><ul><ul><li>Q= Desired dose (mg) X vol of stock preparation(cc) </li></ul></ul><ul><li>Stock dose </li></ul><ul><li>Ex: give 1000mg sulperazone iv q8 stock dose is 1500mg dillute it in 10cc </li></ul><ul><li>Solution:1000mg/ 1.5mg x 10cc = 6.67cc iv q 8 </li></ul><ul><li>Ex: dormicum 7.5 mg was ordered for a px having difficulty to sleep stock dose of dormicum is 15mg/tab. How many tablet will you give? </li></ul><ul><li>What time will you give the drug? </li></ul><ul><li>Ex: glucophage tab 750mg od was started for a diabetic px. Stock dose is 500mg /tab. Ho many will you give? Nursing considerations? </li></ul>
  44. 44. <ul><li>IV FLUID RATE: </li></ul><ul><li>Macrodrops per minute(gtts/min) </li></ul><ul><li>= total IVF vol(cc) x 15gtts/cc #hrs(infusion time) x 60min/hr </li></ul><ul><li>Ex hook D5Lr 1L x 8 hrs, 16 hrs, 4 hrs. </li></ul><ul><li>Solution: 1000cc x 15 gtts /cc </li></ul><ul><li>8 hrs x 60 min/ hr </li></ul><ul><ul><ul><ul><li>=15000 gtts / cc </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>480 min/hr </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>=31.25cc/min </li></ul></ul></ul></ul>
  45. 45. <ul><li>cc / hour </li></ul><ul><li>Volume of iv fluid = cc/ hr </li></ul><ul><li># hours to be infuse </li></ul><ul><li>Ex: start Pnss 1Liter x 8 hours for a DM patient </li></ul><ul><li>1000cc = 125cc/ hr </li></ul><ul><li>8 hour </li></ul>
  46. 46. <ul><li>Conversion (annex) </li></ul><ul><li>Conversion of T° </li></ul><ul><li>°C to ° F = (° C x 1.8) + 32 = °F </li></ul><ul><li>°F to ° C = (°F - 32) (.55) =°C </li></ul><ul><li>Ex. px has 39.5°c during admission.using the formula, convert it to °F </li></ul><ul><li>(39.5C x 1.8) + 32 = 103.°F </li></ul><ul><li>Ex.3y/o child has dengue,100.3 °F convert it to °C using the formula </li></ul><ul><li>(100.3°F - 32) (.55) = 37.5°C </li></ul>
  47. 47. <ul><li>Computation (annex) pediatric doses </li></ul><ul><li>Frieds’s rule: for a child less than 1y/old </li></ul><ul><li>childs dose(age ≤1y/o)= infants age(in mos.) </li></ul><ul><li>150 mos. </li></ul><ul><li>x ave. adult dose </li></ul><ul><li>Young’s rule: children 1-12 y/o </li></ul><ul><li>childs dose (age1-12 y/o) = childs age (in yrs.) </li></ul><ul><li>child’s age (in yrs.) +12 </li></ul><ul><li>x ave. adult dose </li></ul><ul><li>Clark’s rule : </li></ul><ul><li>wt. in lbs x usual adult dose = safe child’s dose </li></ul><ul><li>150 lbs </li></ul>
  48. 48. <ul><li>NERVOUS SYSTEM - operates through the use of electrical impulse and chemical messengers to transmit information throughout the body and to respond into internal & external stimuli. </li></ul><ul><ul><li>CENTRAL NERVOUS SYSTEM </li></ul></ul><ul><ul><li>AUTONOMIC NERVOUS SYTEM </li></ul></ul><ul><ul><li>PERIPHERAL NERVOUS SYSYTEM </li></ul></ul><ul><li>NEURONS – basic functional unit of the nervous system, about 14 billion are located in the brain the rest in the SC, PNS . </li></ul><ul><ul><li>PARTS: </li></ul></ul><ul><ul><ul><li>DENDRITE – Short, branchlike projections that conveys information from one neuron towards another neuron . </li></ul></ul></ul><ul><ul><ul><li>CELL BODY ( SOMA ) – largest part of the neuron </li></ul></ul></ul><ul><ul><ul><li>AXON - Elongated, carries information away from the neuron . </li></ul></ul></ul><ul><ul><li>EFFECTOR CELLS – Receives the signal sent by the axon(cells, muscles, glands, or another nerve) </li></ul></ul><ul><ul><li>AFFERENT FIBERS - Nerve axons that run from PNS to CNS </li></ul></ul><ul><ul><li>EFFERENT FIBERS - Nerve axons that carry impulse from the CNS to Periphery </li></ul></ul>
  49. 49. <ul><li>Action potential – Electrical impulse sent by the nerves </li></ul><ul><ul><li>☻ cell membranes & nerve membranes have pores or channels that controls the movement of a substance in & out of the cell </li></ul></ul><ul><ul><li>☻ some of these channels allows entry & exit of Na, K, Ca </li></ul></ul><ul><ul><li>☻ when cells are at rest, membranes are impermeable to Na but permeable to K </li></ul></ul><ul><li>Depolarization – Na channels open in response to the stimulus Na ions rush inside the cell (positive rush of Ion ) ☻a nerve cannot be stimulated again during depolarized stage☻ </li></ul><ul><li>Repolarization - return of the cellular environment to the resting membrane potential ☻stage of responding / balance bet. Na & K occurs ☻ </li></ul><ul><li>Resting membrane potential- negative environment inside the cell </li></ul>
  50. 50. <ul><li>NERVE SYNAPSE – Where the communication bet.2 nerve occurs thru the release of a Neurotransmitter </li></ul><ul><ul><li>NEUROTRANSMITTER - chemical that stimulates the receptor sites by exciting or inhibiting them </li></ul></ul><ul><ul><li>☻ may either be reabsorbed (reuptake) or broken down by the enzymes in the area Ex. (MAO breaks down the neurotransmitter Epinephrine) (Acetylcholinesterase breaks don the neurotransmitter acethylcholine)☻ </li></ul></ul><ul><li>SELECTED NEUROTRANSMITTER </li></ul><ul><li>Acetylcholine – communicates in the Ms & N, neurotransmitter in the ANS & Parasympathetic </li></ul><ul><li>Norepi / Epi – classified as catecholamines eurotransmitter released by the sympathetic branch of the ANS, released as a hormone by the adrenal medulla </li></ul><ul><li>Dopamine – found in ↑ amts. In the brain for coordination of impulse & responses both motor & intellectual. heart ? </li></ul>
  51. 51. <ul><li>Gamma amino butyric acid (GABA) – found in the brain, inhibits or stimulation nerve activity & important in preventing overexcitability or stimulation such as seizure activity </li></ul><ul><li>Serotonin – found in the limbic system, important for the in arousal and sleep, prevention of depression and motivation promotion </li></ul><ul><li>Ω limbic system – area of the brain that contains ↑ amounts of neurotransmitters ( epi / norepi / serotonin) if responsible for the expressions of emotions ( anger, pleasure, motivation, how a person learns & react to stimuli) Ω </li></ul>
  52. 52. <ul><li>ANXIOLYTICS & HYPNOTIC AGENTS </li></ul><ul><li>ANXIOLYTICS – D rugs that alter ‘s the individual’s response to the environment, prevents feelings of tension or fear </li></ul><ul><ul><li>ANXIETY - a feeling of tension, nervousness, apprehension, or fear that usually involves unpleasant reactions to stimulus </li></ul></ul><ul><li>HYPNOTICS – Drugs causes sleep or minor tranquilizers (provides hypnosis & sense of tranquility in anxious pxs) </li></ul><ul><ul><li>HYPNOSIS – Result of extreme sedation & CNS depression / sleep. </li></ul></ul><ul><li>SEDATIVES – Drugs that cause calmness, unaware of environment </li></ul><ul><ul><li>SEDATION - Loss of awareness and reaction to environmental stimulus. Desirable in (restless, nervous, irritable, or overreacting to a stimulus pxs) </li></ul></ul>
  53. 53. <ul><li>BENZODIAZEPINES: Most frequently used anxiolytics: prevents anxiety w/out causing much sedation </li></ul><ul><ul><li>ALPRAZOLAM / XANOR </li></ul></ul><ul><ul><li>LORAZEPAM / ATIVAN </li></ul></ul><ul><ul><li>DIAZEPAM / VALIUM </li></ul></ul><ul><li>Action: Acts in the limbic system & RAS to make GABA more effective causing interference in neuron firing. </li></ul><ul><li>Indication : anxiety d/o, AWS, hyperexcitability,agitation. </li></ul><ul><li>Pharmacokinetics: well absorbed in the GI,peaks30min- 2hrs, lipid soluble, crosses the placenta, enters breastmilk, </li></ul><ul><li>CIx : +allergy, psychosis, shock, coma, narrow > glaucoma, acute alcohol intoxication, pregnancy, </li></ul><ul><li>Cautions: elderly or debilitated px </li></ul><ul><li>Adverse effects : Mild drowsiness, depression, lethargy,fatigue, restlessness, bradycardia, changes in libido, drug dependence. </li></ul><ul><li>Antidote: Flumazenil / Romazicon : </li></ul>
  54. 54. <ul><li>BARBITURATES: former drug of choice prior to benzodiazepines, risk of addiction , and dependence </li></ul><ul><ul><li>PHENOBARBITAL / LUMINAL </li></ul></ul><ul><ul><li>BUTABARBITAL/ BUTISOL </li></ul></ul><ul><li>Action : CNS depressants ↓ neuronal impulse conduction in the RAS, ↓ cerebral cortex, alters cerebellar fxn, ↓motor output . </li></ul><ul><li>Ix : Anxiety, sedation, insomnia, seizures, acute manic reactions. </li></ul><ul><li>Pharmacokinetics: absorbed well, peaks20-60mins.,induces liver enzymes systems. lipid soluble, crosses placenta, enters breast milk </li></ul><ul><li>CIx: +allergy, hepatic / kidney / respiratory d/o dse., pregnancy. </li></ul><ul><li>Cautions : acute or paradoxical pain (masking?), lactating women </li></ul><ul><li>Adverse effects : somnolence, agitation, confusion, hyperkinesia, ↓BP, syncope, apnea, Stevens- Johnsons </li></ul>
  55. 55. <ul><li>OTHER ANXIOLYTICS & HYPNOTICS : does not fall to benzodiazepines or barbiturates. </li></ul><ul><ul><li>AH’s: Benadryl / Dipenhydramine, Phenergan / Promethazine: can be sedating for some peoples, Tx for mild insomnia </li></ul></ul><ul><ul><li>Paraldehyde / Paral : sedates px c delirium tremens or psych conditions characterized by extreme excitement. Excreted by the lungs and urine </li></ul></ul><ul><ul><li>Buspirone / Buspar : anti anxiety agent, (-) sedative, anticonvulsant,Ms relaxant properties, </li></ul></ul>
  56. 56. <ul><li>AUTONOMIC NERVOUS SYSYTEM: involuntary, visceral nervous system (hypothalamus, medulla & SC) </li></ul><ul><li>DIVISIONS: </li></ul><ul><ul><li>PARASYMPATHETIC / CRANIO SACRAL DIVISION </li></ul></ul><ul><ul><li>SYMPATHETIC / THORACOLUMBAR DIVISION </li></ul></ul><ul><li>SYMPATETHIC - fight or flight ↑ CV fxn, BP, PR, RR, dilated pupils, bronchi’s dilate, ↑blood flow to the skeletal Ms., sweating↑, piloerection ,↑RAAS, GLYCOGENOLYSIS, ↓ </li></ul><ul><li>Adrenergic Transmission: sympathetic nerves that synthesize,stores, release Norepinephrine </li></ul><ul><ul><li>RECEPTORS: </li></ul></ul><ul><ul><ul><li>ADRENERGIC : </li></ul></ul></ul><ul><ul><ul><li>ALPHA ADRENERGIC : (ALPHA 1,) FOUND IN THE BLOOD VESSELS(VASOCONSTRICTORS), IRIS(DILATION), URINARY BLADDER(CONSTRICTION) </li></ul></ul></ul><ul><ul><ul><li>ALPHA ADRENERGIC :(ALPHA 2) LOCATED IN THE NERVE MEMBRANES, MODULATORS FOR THE RELEASE OF NOR EPI </li></ul></ul></ul><ul><ul><ul><li>BETA RECEPTORS : </li></ul></ul></ul><ul><ul><ul><li>BETA 1: FOUND IN CARDIAC TISSUE HAVING (+) INOTROPIC, CHRONOTROPIC EFFECT,↑LIPOLYSIS </li></ul></ul></ul><ul><ul><ul><li>BETA 2 : FOUND IN THE SMOOTH Ms.,PERIPHERY(↑Ms & LIVER GLYCOGEN BREAKDON) BLOOD VESSELS(VASODILATION), PERIPHERY, UTERINE Ms.(RELAXED UTERINE MS. </li></ul></ul></ul>
  57. 57. <ul><li>PARASYMPATHETIC - Rest & digest ↑GI motility & secretions, ↓HR, BP,RR, pupillary dilation </li></ul><ul><li>Cholinergic Transmission:Neurons that uses ACh </li></ul><ul><ul><li>Cholinergic drugs: promotes the action of Acetylcholine </li></ul></ul><ul><ul><li>Aka parasympathomimetic drug </li></ul></ul><ul><li>Major classes </li></ul><ul><li>Cholinergic agonist – mimics the action of acetylcholine, stimulates cholinergic receptors </li></ul><ul><li>Anticholinesterase – inhibits acetylcholinesterase, as a result, acetycholine is not broken down and begins to accumulate thus the effect of acetylcholine is prolonged </li></ul>
  58. 58. <ul><li>DIRECT CHOLINERGIC AGONIST: </li></ul><ul><ul><li>URECHOLINE </li></ul></ul><ul><ul><li>PILOCARPINE </li></ul></ul><ul><li>Action: Parasympathetic action that ↓HR,(-)inotropic effect, vasodialtion, bronchoconstriction, ↑mucus, GI activity, bladder tone, relaxed GI, Bladder sphincters, pupil constriction(miosis). </li></ul><ul><li>Indications: Acute post op, non obstructive urinary retention, bladder atony c retention </li></ul><ul><li>Pharmacokinetics: short half life (1-6hrs), well absorbed </li></ul><ul><li>CIx: (+) allergy,pregnant & lactating px’s, Bradycardia, Hypotension, CAD,asthma, </li></ul><ul><li>Adverse effects: N & V, cramps, diarrhea,↑salivation, Bradycardia, heart block,hypotension, Cardiac arrest , Urinary urgency. </li></ul>
  59. 59. <ul><li>INDIRECT CHOLINERGIC AGONIST: does not react c ACh receptor sites directly. reacts c Acetylcholinesterase(enzyme responsible for breakdown of Ach) </li></ul><ul><ul><li>NEOSTIGMINE </li></ul></ul><ul><ul><li>PYRIDOSTIGMINE </li></ul></ul><ul><li>Action: cholinesterase inhibitor, ↑ ACh level faciltation of nerve transmission </li></ul><ul><li>Indication: Myasthenia gravis , myasthenic crisis </li></ul><ul><li>Pharmacokinetics: duration of 2-4 hrs,must be given every few hours </li></ul><ul><ul><li>(Pyridostigmine=3-6hrs), does not need to be taken frequently, Oral & Parenteral form, can be given in px that inhaled nerve gases </li></ul></ul><ul><li>CIx: cholinergic crisis </li></ul><ul><ul><li>(Endophonium iv=used to distinguish if the px is having w/c type of crisis is happening to the px.) </li></ul></ul>
  60. 60. <ul><li>Adverse effects:Bradycardia, Cardiac arrest, tearing,dysphagia, N & V, ↑bronchial secretions, incontinence, urinary frequency. </li></ul><ul><li>Myasthenic Crisis – px condition improved p endophonium iv injection </li></ul><ul><li>Cholinergic Crisis – px condition gets worst p giving endophonium iv injection </li></ul><ul><li>Tensilon Test – Dx test for Myasthenia Gravis </li></ul><ul><li>☻ ALL MYASTHENIA GRAVIS DRUGS DOES NOT CROSS THE BLOOD BRAIN BARRIER☻ </li></ul>
  61. 61. <ul><li>Alzheimer’s dse – progressive neural degeneration in the cortex leading to a marked memory loss & inability to do ADL’s.- ↑ loss of Ach producing hormones </li></ul><ul><ul><li>TACRINE (COGNEX)- mild – mod. dementia . </li></ul></ul><ul><ul><li>GALANTAMINE (REMINYL)- mild – mod dementia </li></ul></ul><ul><ul><li>RIVASTIGMINE (EXCELON)- liquid, capsule prep </li></ul></ul><ul><ul><li>DONEZEPIL (ARICEPT)- o.d. dose only </li></ul></ul><ul><li>Action:indirect cholinergic blocks Ach’ase at the cells of the cortex & crosses the BBB </li></ul><ul><li>Pharmacokinetics- metabolized by the liver, excreted by the kidney </li></ul><ul><li>CIx Cautions:(+) allergy, Liver dse. Pregnant & lactating,bradycardic, intestinal & urinary obstruction </li></ul><ul><li>Adverse effect:Insomnia, fatigue, rash,N&V,Ms cramps </li></ul>
  62. 62. <ul><li>Anticholinergic Drugs- used to block the effects of Ach & the PNS (Parasympatholytic agents) </li></ul><ul><li>BELLADONA: </li></ul><ul><ul><li>ATROPINE ( oral, parenteral, topical ) </li></ul></ul><ul><li>Action : blocks the effect of PNS there by promoting SNS effects(dilate pupils, ↑HR,RR,PR, ↓GI, URINARY, BLADDER FXN,salivation,bronchial secretions,) </li></ul><ul><li>Ix: preop px, severe bradycardia,hyperactive bowel,pylorospasm </li></ul><ul><li>Pharmacokinetics: well absorbed,cross the BBB,excreted in the urine </li></ul><ul><li>CIx / Cautions: (+) allergy, glaucoma,GI obstruction,Prostate enlargement,bladder obstruction,tachycardia,myocardial ischemia,liver & kidney problem,breastfeeding & lactating px. </li></ul><ul><li>Adverse effects: blurred vision, ↑IOP °, cyclopegia,Gi disturbance,dry mouth, insomnia,heartburn, constipation etc </li></ul><ul><ul><li>SCOPALAMINE, DICYCLOMINE,PROPANTHELINE </li></ul></ul>
  63. 63. <ul><li>PARKINSONS DSE - progressive neurologic d/o due to marked degeneration in the brain(basal ganglia & substantia nigra) thereby affecting Corpus striatum (helps maintain Ms tone not related to any movement) </li></ul><ul><ul><ul><li>tremors leading to rigidity, weakness, bradykinesia, simian posture, difficulty in performing intentional movements, shuffling gait, slurred speech, mask face </li></ul></ul></ul><ul><li>* corpus striatum is connected to substantia nigra by series of neuron that uses inhibitory GABA </li></ul><ul><li>* substantia nigra sends back impulse to corpus striatum using the inhibitory neurotransmitter Dopamine </li></ul>
  64. 64. <ul><li>☻ higher neurons from the cerebral cortex secrete Ach in the corpus striatum as an excitatory neurotransmitter to coordinate intentional movements of the body=☻ </li></ul><ul><li>☻↓ dopamine in the area causes imbalance that allows the cholinergic / excitatory cells to dominate = ☻ </li></ul><ul><li>☻ affecting the fxn of basal ganglia & extrapyramidal motor system (provides coordination for unconscious Ms movements Ex. Position, posture, movement) ☻ </li></ul>
  65. 65. <ul><li>type 1(inhibition) antiparkinsonian drug: </li></ul><ul><ul><li>Dopaminergic : ↑ effects of dopa @ receptor sites,does not cross BBB proven to be much more effectve than Anticholinergics </li></ul></ul><ul><li>* effective only if there’s enough intact neuron in the substantia nigra (unextensive degeneration) </li></ul><ul><ul><li>Levodopa (Dopar): precursor of dopamine, crosses the BBB then converted to dopamine usually given c </li></ul></ul><ul><ul><li>Carbidopa (Sinemet)= ↓ the effect of dopa decarboxylase enzyme in the GI tract & periphery leading to ↑ dopamine converted in the brain </li></ul></ul><ul><ul><li>Amantadine(Symmetrel)- antiviral, ↑release of dopa </li></ul></ul><ul><ul><li>Bromocryptine (Parlodel)- dopa agononist acting on dopa receptor directly-does not need further metabolism(more effective than dopar & Sinnemet </li></ul></ul>
  66. 66. <ul><ul><li>Pergolide (Permax )- adjunct to carbi-levodopa. </li></ul></ul><ul><ul><li>Pramipexole (Mirapex)- effective if levodopa effect has decreased </li></ul></ul><ul><ul><li>Ropinirole (Requip) – new drug. Used in early & late stage of PD when levodopa has lost its adequate effect. </li></ul></ul><ul><ul><li>Apomorphine iv (Apokyn)- new drug.dopa agonist that manages hypomobility in PD.given SQ route </li></ul></ul><ul><li>Actions: ↑ level of dopa in the substantia nigra </li></ul><ul><li>Pharmacokinetics: absorbed well in GI & body </li></ul><ul><li>CIx/ ^Cautions : (+)allergy, closed angle glaucoma,^CVD, asthma,liver, renal dse. </li></ul><ul><li>Adverse effects:anxiety,nervousness,arrythmias </li></ul>
  67. 67. <ul><li>type 2 (stimulation) antiparkinsonian drug: </li></ul><ul><ul><li>Anticholinergics: opposes the effects of Ach @ receptor sites in the </li></ul></ul><ul><ul><ul><li>Benztropine (Cogentin)- oral,im,iv for parkinsons due to phenothiazines </li></ul></ul></ul><ul><ul><ul><li>Biperiden (Akineton)- oral, im, adjunctive tx for PD due to phenothiazines </li></ul></ul></ul><ul><ul><ul><li>Dipenhydramine (Benadryl) used in px ho cannot tolerate more potent type of anti PD drugs(Old pxs) </li></ul></ul></ul><ul><ul><ul><li>Procyclidine (Kemadrin)- oral,for any type of parkinsonism, controls excessive salivation due to use of neuroleptics </li></ul></ul></ul><ul><ul><ul><li>Trihexyphenidyl ( Artane)- used c levodopa, used alone for control of drug induced Extrapyramidal d/o. </li></ul></ul></ul>
  68. 68. <ul><li>Action: ↓ tremors & rigidity, drooling assoc. c PD </li></ul><ul><li>Ix: Parkinsons dse., Parkinsonism(idiopathic, atherosclerotic,postencephalitic)releif of Extrapyramidal d/o due to phenothiazines </li></ul><ul><li>Pharmacokinetics :variable absorption in GI, 1-4 hrs, metabolized in the liver </li></ul><ul><li>CIx /^ Cautions: (+) allergy, closed angle glaucoma,GI, GU obstructions, prostate enlargement ^tachycardia, hypo/hypertension, pregnant & lactating px </li></ul><ul><li>Adverse effects : disorientation,confusion, memory loss, agitation,delirium,weakness,dry mouth, N & V, ↓ GI, GU activity </li></ul>
  69. 69. <ul><li>Psychotherapeutic Agents: drugs aiding in the Tx Mx of mental d/o. </li></ul><ul><li>Psychosis: perceptual & behavioral d/o </li></ul><ul><ul><li>Schizophrenia- most common type. (hallucinations, paranoia, delusion, speech abnormality, affective problems) strong genetic predisposition </li></ul></ul><ul><ul><li>Mania- assoc. c bipolar illness (manic-depressive) periods of extreme depression followed by hyperactivity & excitement. </li></ul></ul><ul><ul><li>Narcolepsy- char. by daytime sleepiness &sudden loss of wakefulness. Problem c RAS </li></ul></ul><ul><ul><li>Attention-deficit d/o- inability to concentrate on an activity for longer than a few minutes & hyperkinesis </li></ul></ul>
  70. 70. <ul><li>Antipsychotic /Neuroleptics, Major tranquilizers </li></ul><ul><ul><li>Antipsychotic - eliminate S/Sx of psychosis </li></ul></ul><ul><ul><li>Neuroleptic- adverse neurobiologic effect causing abnormal body movements </li></ul></ul><ul><ul><li>Major Tranquilizers- can calm agitated patient </li></ul></ul><ul><li>Major types: Typical & Atypical </li></ul><ul><ul><li>TYPICAL –dopamine receptor blocker{Phenothiazines} Ex: Chlorpromazine/Thorazine, Fluphenazine/Prolixin,Haldol/haloperidol </li></ul></ul><ul><li>Action: blocks dopa receptor,prevents stimulation of neuron by dopa,depress RAS </li></ul>
  71. 71. <ul><li>Ix : hallucination, schizophrenia, anxious/agitated px, dellusions, ADHD </li></ul><ul><li>Pharmacokinetics: absorbed in GI, still present 6mos, p last dose, children metabolizes drugs faster than old px </li></ul><ul><li>CIx/^ Cautions: (+) allergy, PD, CAD, blood dyscrasia, ^glaucoma, PUD, GI/Urinary obstruction </li></ul><ul><li>Adverse Reaction: weakness, EPS (dystonia, akathisia, tardive dyskinesia), hypotension, urine color turns pink to reddish brown (minor harmless effect) </li></ul>
  72. 72. <ul><li>Atypical- blocks dopa & serotonin receptors </li></ul><ul><li>Ex. Clozapine, Olanzapine, Risperidone,Quetiapine, </li></ul><ul><li>Action: blocks dopa & serotonin receptors, depress RAS </li></ul><ul><li>Ix: Schizophrenia unresponsive to typical type, </li></ul><ul><li>Pharmacotherapeutics: 4-12hrs, metabolized in the liver excreted in urine & feces. </li></ul><ul><li>Adverse effects: drowsiness, sedation, seizures, diziness </li></ul>
  73. 73. <ul><li>MANIC- opposite of depression, overstimulation of certain neurons in the brain </li></ul><ul><li>ANTI MANIC DRUGS- drugs used to treat manic d/o Ex: Lithium salt, Lamictal, Seroquel,Zyprexa </li></ul><ul><li>Ix: Manic d/o, Manic-depressive (bipolar) </li></ul><ul><li>Action: alters Na transport in Ms & Nerves;( ↓ dopa & norepi but not serotonin) Neurons; ( ↑ storage of neuronal dopa & nor epi, ↓ content of 2 nd messengers ) </li></ul><ul><li>Pharmacokinetics- absorbed in GI,30min-3hrs peak level when px is dehydrated: lithium more absorbed than Na=toxic level,enters breastmilk. </li></ul><ul><li>CIx / ^Caution:(+) allergy, Renal, Liver, Cardiac Dse. Dehydration( ↓ Na ),pregnant & lactating px </li></ul>
  74. 74. <ul><li>Adverse effects: therapeutic level: 0.6- 1.2mEq/L </li></ul><ul><li>Serum level 1.5=CNS problem: lethargy, slurred speech, Ms. weakness, fine tremor,renal gastric toxicity </li></ul><ul><li>Serum level 1.5-2= Intensified above S/Sx +ECG changes </li></ul><ul><li>Serum level 2~2.5= progression of effects renal pulmonary fatalities </li></ul><ul><li>Serum level >2.5= Complex multi organ toxicity c significant risk of death </li></ul>
  75. 75. <ul><li>CNS Stimulants: Tx for attention deficit d/o & narcolepsy, </li></ul><ul><ul><li>Methylpenidate/Ritalin,Concerta-both </li></ul></ul><ul><ul><li>Dexmethylpenidate/Focalin- Ix:6y/o px only </li></ul></ul><ul><ul><li>Dextroamphetamine/Dexedrine </li></ul></ul><ul><ul><li>Modafinil/Provigil-narcolepsy </li></ul></ul><ul><ul><li>Pemoline/Cylert-adhd </li></ul></ul><ul><li>Action: releases catecholamines from presynaptic neuron= increase stimulation of post synaptic neurons </li></ul><ul><li>Pharmacokinetics: rapidly absorbed in GI,peaks 2-4hrs. Half life =2-15hrs </li></ul>
  76. 76. <ul><li>CIx /^Cautions : (+) allergy, anxiety, agitation,fatigue, galucoma,^hx of seizures, drug dependence,alcoholics </li></ul><ul><li>Adverse effects : nervousness,insomnia,dizziness, headache,blurred vision & difficulty c accomodation, anorexia, nausea, wt. loss, HPN, arrythmias, angina, </li></ul>
  77. 77. <ul><li>Epilepsy - sudden dc of excessive electrical energy from the cells of the brain. </li></ul><ul><li>Classifications: </li></ul><ul><ul><li>Generalized- begins in one area of the brain & rapidly spread throughout both hemispheres.px often loses consciousness as a result of massive abnormal electrical brain activity </li></ul></ul><ul><ul><li>Tonic-clonic -aka Grand mal, loss of consciousness, confusion & exhaustion upon recovery </li></ul></ul><ul><ul><li>Absence- aka petit mal, abrupt, brief(3-5secs)loss of consciousness </li></ul></ul>
  78. 78. <ul><ul><li>Myoclonic- short, sporadic periods of Ms contraction for several minutes </li></ul></ul><ul><ul><li>Febrile-most common in children, </li></ul></ul><ul><ul><li>Status epilipticus- most dangerous type seizures recur over & over </li></ul></ul><ul><li>Partial – aka focal seizures , involves one area of the brain, S/Sx depend on exactly where the abnormality occurs. </li></ul><ul><ul><li>Simple partial – single area of the brain affects a single Ms. </li></ul></ul><ul><ul><li>Complex partial- hallucinations,mental distortion,involuntary urination </li></ul></ul>
  79. 79. <ul><li>Drugs for tonic-clonic seizures </li></ul><ul><li>HYDANTOINS- stabilizes N membranes & limit the spread of excitability. </li></ul><ul><ul><li>Phenytoin (Dilantin) – therapeutic level10-20ug/ml </li></ul></ul><ul><ul><li>Ethotoin (Peganone) – therapeutic level 15-50ug/ml </li></ul></ul><ul><ul><li>Fosphenytoin (Cerebyx) – short acting </li></ul></ul><ul><ul><li>Mephynytoin (Mesantoin) –sev. multi system toxicity </li></ul></ul><ul><li>Ix: tonic-clonic seizures </li></ul><ul><li>Pharmacokinetics: 6-4hr:met. In liver,excreted by kidney </li></ul><ul><li>CIx ^Cautions: (+)allergy, hepatic & renal dse. </li></ul><ul><li>Adverse effects: nystagmus, ataxia, slurred speech, confusion, S’s J’s syndrome fatigue. </li></ul>
  80. 80. <ul><li>BARBITURATES & B -LIKE DRUGS </li></ul><ul><ul><li>Phenobarbital( Luminal)–therapeutic level 15-40ug/ml </li></ul></ul><ul><ul><li>Primidone (Mysoline)-therapeutic level 5-12ug/ml </li></ul></ul><ul><ul><li>Mephobarbital (Mebaral)-causes ↓BP,↓HR, circulatory collapse. </li></ul></ul><ul><li>Action: CNS depressants, inhibits impulse & conduction in the ascending RAS, ↓cerebellar fxn, ↓motor output </li></ul><ul><li>Pharmacokinetics: 79 hr: metabolism </li></ul><ul><li>Adverse effects: Somnolence, insomnia, vertigo, nightmares, lethargy, nervousness, bradycardia, depression, withdrawal syndrome </li></ul>
  81. 81. <ul><li>BENZODIAZEPINES- ↑ the effects of GABA(causes stimulation of Limbic & RAS) </li></ul><ul><ul><li>DIAZEPAM (Valium)-releives tension, anxiety & Ms spasm, not used for long time Tx of seizures half life= 20-50 hrs </li></ul></ul><ul><ul><li>CLONAZEPAM (Klonopin)-usu for petit mal & myoclonic half life =18-50hrs </li></ul></ul><ul><li>Ix: Anxiety d/o, AWS, Ms relaxant, Status Epilipticus </li></ul><ul><li>CIx ^ Cautions: allergy, pregnant, liver kidney dse. </li></ul><ul><li>Adverse effects: drowsiness, sedation, depression, disorientation,diarrhea, incontinence, withdrawal </li></ul>
  82. 82. <ul><li>PETIT MAL DRUGS </li></ul><ul><li>SUCCINIMIDES – supresses the abnormal elctrical activity in the brain </li></ul><ul><ul><li>ETHOSUXIMIDE (Zarontin)- drug of choice for petit mals/ absence seizures,often used first. thera level=40-100ug/ml </li></ul></ul><ul><ul><li>METHSUXIMIDE (Celontin)- can cause bone marrow depression. </li></ul></ul><ul><li>Pharmacokinetics: peaks 1-7 hrs, halflife: 30-60hrs, metabolized in liver, excreted in the urine & bile </li></ul><ul><li>CIx ^ Cautions: allergy, renal, hepatic dse, pregnancy </li></ul><ul><li>Adverse effects: drosiness, ataxia, headache,diarrhea </li></ul>
  83. 83. <ul><li>PETIT MALS DRUGS (annex) </li></ul><ul><ul><li>Depakene (Valproic acid)- drug of choice in tx myoclonic seizures peaks 1-4 hrs. half life 6-16 hrs </li></ul></ul><ul><ul><li>Acetazolamide (Diamox)- for absence seizure in children, for open angle glaucoma, ↓edema in CHF px s, half life 2.5 – 6 hrs. </li></ul></ul><ul><ul><li>Zonisamide (Zonegram) – new drug. Inhibits voltage sensitive Na & Ca channels, px should be hydrated due to possibilities of renal calculi </li></ul></ul>
  84. 84. <ul><li>FOCAL SEIZURE DRUGS </li></ul><ul><ul><li>CARBAMAZEPINE (Tegretol) – drug of choice, ability to block Na channels to prevent repetitive action potentials in the abnormal focus </li></ul></ul><ul><ul><li>CLORAZEPATE (Tranxene) –also used for anxiety, alcohol wihtdrawal </li></ul></ul><ul><ul><li>FELBAMATE (Felbatol) – usually given if other medications fail.causes liver toxicity & aplastic anemia </li></ul></ul><ul><ul><li>GABAPENTIN (Neurontin) – adjunctive therapy for other seizure drugs </li></ul></ul><ul><ul><li>LAMOTRIGINE (Lamictal) – adjunctive therapy </li></ul></ul>
  85. 85. <ul><ul><li>LEVETIRACETAM (Keppra)- newer drug,renal toxicity </li></ul></ul><ul><ul><li>OXCARBAZEPINE (Trileptal) – for px 4-16 y/o </li></ul></ul><ul><ul><li>TOPIRAMATE (Topamax)- interferes Na channels causing stability of nerve membranes </li></ul></ul><ul><li>CIx^ Cautions:(+) allergy, bone marrow supression,^pregnancy, liver & kidney dse. </li></ul><ul><li>Adverse effects: drowsiness, ataxia, dizziness, nausea, vomiting, hepatitis, CV complications, S’s J’s syndrome </li></ul>
  86. 86. <ul><li>PAIN – sensory & emotional experience assoc.w /actual or potential tse damage. </li></ul><ul><li>PAIN PERCEPTION: </li></ul><ul><li>Painful stimulus  free nerve endings (nociceptors)  release of prostaglandin  pain receptors (A-delta-small, fast,myelinated fiber / Cfiber-slow,unmyelinated)  ascending tracts (spinothalamic tracts-beginning of the gate control theory)  hypothalamus  thalamus  cerebral cortex </li></ul>
  87. 87. <ul><li>NARCOTICS - aka opiods. </li></ul><ul><li>OPIOD RECEPTORS- receptors (CNS, GI, Periphery)that respond to endogenous opiates (Endorphin, Enkephalin) </li></ul><ul><ul><li>BRAINSTEM-opioid receptors helps control BP, pupil diameter. </li></ul></ul><ul><ul><li>GI- opioid receptors regulates N & V cough </li></ul></ul><ul><ul><li>SC & THALAMUS- opioid receptors help integrate & relate incoming info abt. Pain </li></ul></ul><ul><ul><li>HYPOTHALAMUS- opioid rceptors interrelate the endocrine & neural response to pain </li></ul></ul><ul><ul><li>LIMBIC SYSYTEM- opioid receptors incorporate emotional aspects of pain & response to pain. </li></ul></ul>
  88. 88. <ul><li>Peripheral Nerve sites- opioid receptors may block release of neurotransmitters that are related to pain & inflammation </li></ul><ul><li>4 types of opiod receptors </li></ul><ul><ul><li>Mu(u) - 1°pain blocking receptors (analgesia) ↓RR, GI activity, euphoria, ↑pupil constriction </li></ul></ul><ul><ul><li>Kappa (k)- assoc. c some analgesia, pupil constriction, sedation, dysphoria </li></ul></ul><ul><ul><li>Beta(ß)- reacts c enkephalins in the periphery to modulate pain transmission </li></ul></ul><ul><ul><li>Sigma( E )- pupillary dilation, maybe responsible for hallucinations, dysphoria, psychose assoc. c narcotic use </li></ul></ul>
  89. 89. <ul><li>NARCOTIC AGONIST- drugs that react c opioid receptors throughout the body to cause analgesia sedation, euphoria (controlled substance) </li></ul><ul><ul><li>FENTANYL (Duragesic) </li></ul></ul><ul><ul><li>MEPERIDINE (Demerol) </li></ul></ul><ul><ul><li>OXYCODONE (OxyContin) </li></ul></ul><ul><ul><li>MORPHINE (Astramorph) </li></ul></ul><ul><li>Action: analgesia, antitussive, adjuncts to general anesthesia </li></ul><ul><li>Ix : severe acute or chronic pain, pre op meds, analgesia during anesthesia </li></ul><ul><li>Pharmakokinetics: fastest route is iv, greater absorption in male, most are in preg. category C (except oxyxodone –B- do not cut, crash meds!! -Fast effect) </li></ul>
  90. 90. <ul><li>CIx ^ Cautions: (+) allergy, pregnancy, labor, lactation,^ respiratory dysfxn, recent GI & GU surgery, head injuries, alcoholism, liver & kidney dse. </li></ul><ul><li>Adverse effects: respiratory depression, hypotension, shock, biliary spasm, constipation, hallucinations, anxiety, fear, ureteral spasms, dependence </li></ul>
  91. 91. <ul><li>NARCOTIC AGONIST – AGONIST – stimulates certain opioid receptors & blocks some. Has less abuse potential than pure narcotics </li></ul><ul><ul><li>BUPRENORPHINE (Buprinex)- mild-mod. Pain </li></ul></ul><ul><ul><li>BUTORPHANOL (Stadol) – preop med mod.-sev. Pain, effective in tx of migraine headache. </li></ul></ul><ul><ul><li>NALBUPHINE (Nubain) – mod. – sev. Pain, adjunct for gen anesthesia </li></ul></ul><ul><ul><li>PENTAZOCINE (Talwin)- prefered in shifting iv- oral pain killer, highly hallucinogenic & euphoric (+ tripelannamine) </li></ul></ul><ul><li>Pharmacokinetics: well absorbed iv-im, crosses placenta </li></ul>
  92. 92. <ul><li>CIx /^Cautions: allergy,pregnancy, lactation, ^COPD & CV dse px. </li></ul><ul><li>Adverse effects: respiratory depression, apnea, suppression of cough reflex, N & V, constipation, biliary spasm,psychose, lightheadedness, GU & GI affectations </li></ul>
  93. 93. <ul><li>NARCOTIC ANTAGONIST </li></ul><ul><ul><li>NALMEFENE (Revex) </li></ul></ul><ul><ul><li>NALOXONE (Narcan)- tx & dx of narcotic use </li></ul></ul><ul><ul><li>NALTREXONE (ReVia) </li></ul></ul><ul><li>Actions: blocks opioid receptors & reverse the effects of opioids. </li></ul><ul><li>Ix: narcotic overdose (resp. depression, sedation) </li></ul><ul><li>Pharmacokinetics- well absorbed p injection, passes in the placenta & breast milk. </li></ul><ul><li>CIx^Cautions: allergy,^ pregnant / lactating px. </li></ul><ul><li>Adrese effects: acute narcotic abstinence syndrome (n & v, svveating, tachycardia, hypotension, pulmonary edema. </li></ul>
  94. 94. <ul><li>Nsg implementation: </li></ul><ul><ul><li>Maintain patent airway /provide artificial ventilation </li></ul></ul><ul><ul><li>Continous px monitoring </li></ul></ul><ul><ul><li>Administer narcotic antagonist </li></ul></ul><ul><ul><li>Comfort, safety measures </li></ul></ul><ul><ul><li>Thorough health teaching abt. drug ( brand name , dosage, time of taking, cautions etc. ) </li></ul></ul>
  95. 95. <ul><li>MIGRAINE HEADACHES- sev. Throbbing headaches on one side of the head. 2° to arterial dilation </li></ul><ul><ul><li>COMMON- occurs s aura, sev. Unilat. Pulsating pain usu. accompanied by N&V light & sound sensitivity (aggravated by physical activity) </li></ul></ul><ul><ul><li>CLASSIC- preceded by aura, sensation (sensory & motor disturbances .5 hrs prior to headache </li></ul></ul><ul><li>CLUSTER HEADACHES- starts during sleep (Sharp, steady eye pain 15-90mins) c sweating, flushing, tearing & nasal congestion </li></ul><ul><li>TENSION HEADACHE-during stress (dull band of pain around entire head 30mins-1wk.) anorexia, fatigue, mild intoleranec to light / sound. </li></ul>
  96. 96. <ul><li>ERGOT DERIVATIVES-cause cranial vasocontrictions, ↓ pulsations of cranial arteries </li></ul><ul><ul><li>DIHYDROERGOTAMINE (Migranal)-po, iv,nasal spray </li></ul></ul><ul><ul><li>ERGOTAMINE- previous drug of choice, SL </li></ul></ul><ul><li>Actions: blocks alpha adrenergic & serotonin sites in the brain causing constriction of vessels & ° ↓ arterial pulsation </li></ul><ul><li>Ix: prevent & abort vascular & migraine headaches </li></ul><ul><li>Pharmacokinetics: rapidly absorbed c in 30 mins. </li></ul><ul><li>CIx ^Cautions : allergy, pregant & lactating px, ^ pruritus, GI reactions. </li></ul><ul><li>Adverse effects: numbness, tingling fingers & toes, Ms pain, thready pulse, chest pain </li></ul>
  97. 97. <ul><li>Nsg implementation: </li></ul><ul><ul><li>Know px drug Hx/allergy, </li></ul></ul><ul><ul><li>Hx taking for CV dse. </li></ul></ul><ul><ul><li>r/o pregnancy & lactation </li></ul></ul><ul><ul><li>Continous monitoring for any adverse reaction post drug administration. </li></ul></ul><ul><ul><li>Health teaching abt drug being administered. </li></ul></ul>
  98. 98. <ul><li>TRIPTANS- new class. Causes cranial vasoconstriction & migraine relief (-) CV, GI effects vs ergot derivatives </li></ul><ul><ul><li>SUMATRIPTAN (Imitrex)- very effective in cluster headache </li></ul></ul><ul><ul><li>NARATRIPTAN ( Amerge) – causes birth defects </li></ul></ul><ul><ul><li>RIZATRIPTAN (Maxalt) – for migraine (c / s )aura </li></ul></ul><ul><li>Actons: binds to selective serotonin sites causing vasoconstriction </li></ul><ul><li>Ix: Tx but not prevention of migraines </li></ul><ul><li>Pharmacokinetics: liver metabolizes, excreted by kidney, crosses placenta </li></ul>
  99. 99. <ul><li>CIx ^ Cautions: allergy, pregnant / lactating px. ^ elderly px , CAD px </li></ul><ul><li>Adverse effects: dizziness, vertigo, weakness, myalgia, chest pain, tingling, numbness </li></ul><ul><li>Nsg. Implementation: </li></ul><ul><ul><li>know drug allergy / Hx </li></ul></ul><ul><ul><li>Use 10 R’s of drug administration </li></ul></ul><ul><ul><li>Px comfort & safety </li></ul></ul><ul><ul><li>Monitor CV functioning & other VS </li></ul></ul><ul><ul><li>Observe for any adverse effects </li></ul></ul><ul><ul><li>Health teaching </li></ul></ul>
  100. 100. <ul><li>ANESTHETICS: drugs that cause complete/partial loss of sensation </li></ul><ul><ul><li>GENERAL- CNS depressants produces loss of pain & consciousness. blocks body reflex </li></ul></ul><ul><ul><ul><li>Goals: (analgesia, unconsciousness, amnesia) </li></ul></ul></ul><ul><ul><li>Risk Factors: </li></ul></ul><ul><li>CNS= neurological d/o dse (SE, CVA, MG) </li></ul><ul><li>CV= cv dse/abnormality (CAD, hypotension) </li></ul><ul><li>RESPI= abnormal V/Q perfussion ratio (COPD, Asthma, etc) </li></ul><ul><li>Renal & Hepatic: altered met & excretion of drug (ARF, ESRD, Hepa A-E, cirrhosis, etc.) </li></ul><ul><ul><li>LOCAL- cause loss of pain sensation & feeling in a designated area or body part </li></ul></ul>
  101. 101. <ul><li>Balance Anesthesia- use of combination of drug(s) each c a specific effect (analgesia,Ms relaxation, unconsciousness, amnesia) </li></ul><ul><ul><li>Pre op meds- anticholinergics, atropine SO4 </li></ul></ul><ul><ul><li>Sedative-hypnotics - dormicum </li></ul></ul><ul><ul><li>Antiemetics - plasil </li></ul></ul><ul><ul><li>Antihistamines - benadryl </li></ul></ul><ul><ul><li>Narcotics - nubain (nalbuphine) </li></ul></ul><ul><li>Stages of Anesthesia </li></ul><ul><li>Stage 1: Analgesia stage(loss of pain sensation) px is still consciouss & able to communicate </li></ul><ul><li>Stage 2: Excitement stage(excited & may be combative behavior) usu. c SNS response ( ↑ PR, BP, RR) </li></ul>
  102. 102. <ul><li>Stage 3 Surgical Anesthesia (relaxed skeletal Ms, Normal RR, loss of eye reflexes, dilated pupil) surgery can be safely performed </li></ul><ul><li>Stage 4 Medullary Paralysis CNS depression, respiratoty & vasomotor stimuli loss. (death can occur) </li></ul><ul><li>INDUCTION- from beginning of anesthesia – stage 3. *stage 2 = danger pd. </li></ul><ul><li>MAINTENANCE –from stage 3- until surgery is complete (usu. Gas anesthetics given) </li></ul><ul><li>RECOVERY- from dc anesthesia-cosnciousness regained (movement, ability to communicate) *px must be continously monitored* </li></ul>
  103. 103. <ul><li>TYPES OF GEN. ANESTHESIA </li></ul><ul><ul><li>BARBITURATES </li></ul></ul><ul><ul><ul><li>THIOPENTAL (Pentothal)-most common, rapid onset, short recovery pd (- analgesic prop.) </li></ul></ul></ul><ul><ul><ul><li>METHOHEXITAL (Brevital)- rapid onset, must not be in contact c silicon, (- analgesic prop.) causes resp. depression, apnea. </li></ul></ul></ul><ul><ul><li>NON BARBITURATES </li></ul></ul><ul><ul><ul><li>MIDAZOLAM (Dormicum)peaks 30-60mins, N&V are often </li></ul></ul></ul><ul><ul><ul><li>KETAMINE (Ketalar)- causes hallucinations,dreams, psychotic episodes </li></ul></ul></ul><ul><ul><ul><li>DROPERIDOL (Inapsine)- CIx in renal & liver dse. </li></ul></ul></ul>
  104. 104. <ul><li>ANESTHETIC GASES- enters the bronchi & alveoli  capillary system  heart  systemic circulation  tissues/fats (nerves)  brain= CNS depression </li></ul><ul><ul><li>NITROUS OXIDE ( BLUE CYLINDER )- potent analgesic, least toxic usu in dental practice </li></ul></ul><ul><ul><li>Cyclopropane ( orange cylinder ) – not good analgesic,causes headache, N & V, </li></ul></ul><ul><ul><li>Ethylene ( red cylinder )- less toxic, unpleasant taste in mouth </li></ul></ul>
  105. 105. <ul><li>VOLATILE LIQUIDS- unstable gas @ rm T° & release gases </li></ul><ul><ul><li>HALOTHANE (Fluothane)- rapid onset & recovery,( ↓HR, BP, ) liver toxic </li></ul></ul><ul><ul><li>DESFLURANE (Suprane)- causes cough & laryngospasm </li></ul></ul><ul><ul><li>ENFLURANE (Enthrane)- causes renal toxicity, arrythmia </li></ul></ul><ul><ul><li>METHOXYFLURANE (Penthrane)- slow onset, used in labor & delivery </li></ul></ul><ul><ul><li>SEVOFLURANE ( Uthane)- newest form, </li></ul></ul>
  106. 106. <ul><li>LOCAL ANESTHETICS-loss of sensation in local area of the body ( T°, touch, proprioception, skeletal Ms tone) </li></ul><ul><li>TYPES OF ADMINISTRATION: </li></ul><ul><ul><li>TOPICAL-cream, spray, lotion (skin, nose, throat, mouth, urethra, rectal) </li></ul></ul><ul><ul><li>INFILTRATION-injecting directly in area (wound dehis) that needs resuturing </li></ul></ul><ul><ul><li>FIELD BLOCK-injected all around the area that ill be affected by the operation (tooth extraction) </li></ul></ul>
  107. 107. <ul><li>NERVE BLOCK-injected some point along the nerve that’s responsible for the sensation of area involve </li></ul><ul><li>peripheral nerve block- blocks sensory & motor aspectsof a particular nerve for a relief of pain. </li></ul><ul><li>central nerve block-injected into the roots of the nerves </li></ul><ul><li>epidural block-injected in the space where the nerves emerge from the SC </li></ul><ul><li>caudal block-injection in sacral canal below the epidural area </li></ul>
  108. 108. <ul><li>INTRAVENOUS & REGIONAL ANESTHESIA- carefully draining all blood from the extremities, securing it c torniquet (prevent anesthesia from entering the general circulation) & injecting it in the vein. </li></ul><ul><li>GEN. KINDS: </li></ul><ul><ul><li>ESTERS : BENZOCAINE, PROCAINE, TETRACAINE </li></ul></ul><ul><ul><li>AMIDES: LIDOCAINE, BUPIVACAINE, DIBUCAINE, ROPIVACAINE </li></ul></ul><ul><ul><li>OTHERS: DYCLONE, PRAMOXINE </li></ul></ul>
  109. 109. <ul><li>Action: temporary interruption in production & conduction of nerve impulse. </li></ul><ul><ul><ul><li>Affects permeability of nerves membranes to Na ions thereby preventing the nerve from depolarization </li></ul></ul></ul><ul><li>Ix: infiltration, nerve blocks, spinal anesthesia, local pain relief </li></ul><ul><li>Pharmacokinetics: ester types are easily broken down by plasma esterases. amides types are broken down much longer (toxicity prone) </li></ul><ul><li>CIx: ^Cautions: allergy, heart block, shock, ^liver & kidney dse. hypotension </li></ul>
  110. 110. <ul><li>Adverse effects: skin injury, headache, restlessness, anxiety, tremors, blurred vision, N & V, arrythmia, cardiac depression </li></ul><ul><li>Nsg Intervention: </li></ul><ul><ul><li>assess CV & Respiratory function </li></ul></ul><ul><ul><li>Maintain patent airway </li></ul></ul><ul><ul><li>check for gag & swallowing reflex </li></ul></ul><ul><ul><li>Spinal anesth px must remain flat on bed x 12hrs </li></ul></ul><ul><ul><li>Proper hydration </li></ul></ul>
  111. 111. <ul><li>NMJ- area of communication bet. the nerve & Ms. </li></ul><ul><li>Neuromuscular Junction Blocking Agents- blocks the area of communication bet. Nerve & Ms. </li></ul><ul><li>Non Depolarizing NMJ agent: ( CURARE) TUBOCURARINE-adjunct to Gen. anesthesia </li></ul><ul><ul><li>Action: occupies the muscular cholinergic receptor site preventing Ach from reacting c the receptor </li></ul></ul><ul><ul><li>Ix: induce skeletal relaxation, ECT, Ventilated px. </li></ul></ul><ul><ul><li>Pharmacokinetics: metabolized by liver & excreted unchange by the liver </li></ul></ul><ul><ul><li>Adverse effects: respiratory depression, apnea, bronchospasm, cardiac arrythmia. </li></ul></ul>
  112. 112. <ul><li>Depolarizing NMJ blocker: attaches to the Ach receptor site on the Ms cell, depolarizing it.hydrophillic & does not cross BBB </li></ul><ul><li>Succinylcholine - adjunct to gen. anesthesia </li></ul><ul><li>Action: combines c ACh receptors causing flaccid paralysis. Prolongs depolarization (Ms contracts first & then leading to paralysis) </li></ul><ul><li>Ix: facilitate ET intubation, induce skeletal Ms relaxation, ECT, </li></ul><ul><li>Pharmacokinetics: metabolize in the plasma & liver by the use of cholinesterase </li></ul><ul><li>CIx ^ Caution: allergy, MG, renal & hepatic Dse. pregnant^ CV dse. Malignant hyperthermia, </li></ul>
  113. 113. <ul><li>Adverse effects: respiratory depression, Ms paralysis, bronchospasm, hypotension, arrythmias,, GI, dysfxn, paralysis, decubitus ulcer </li></ul><ul><li>Nsg. Implementation: </li></ul><ul><li>Must be given by specialist </li></ul><ul><li>Not be mixed c alkaline soln. </li></ul><ul><li>Monitor px’s overall status & recovery </li></ul><ul><li>Maintain cholinesterase inhibitor </li></ul><ul><li>Maintain cmfort & safety </li></ul><ul><li>Close monitoring of VS & neuro VS </li></ul>

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