Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Nursing Pharmacology Prelim


Published on

Published in: Health & Medicine, Business

Nursing Pharmacology Prelim

  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>
  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>