afams nervous system drugs (insert dari) eo 003.01 part 29

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Nervous System Drugs(Insert Dari)

EO 003.01 Part 29

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Overview of Lesson(Insert Dari)

Anesthetics- General - Local

Analgesics- Opioids- Other analgesics and antipyretics- Anti-migraine preparations

Antiepileptics

Psycholeptics-Antipsychotics-Anxiolytics -Hypnotics and Sedatives

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Overview of Lesson(Insert Dari)

Psychoanaleptics- Antidepressants- Anti-dementia drugs

Other nervous system drugs- Parasympathomimetics- Antivertigo preparations

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What I need to know as a pharmacy technician(Insert Dari)

In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under

(N) Nervous System Drugs

For each of these medications/classes students must obtain an understanding of:

(1) Mechanism of Action

(2) Indications (Uses)

(3) Efficacy

(4) Side Effects

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Anesthetics(Insert Dari)

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Anesthesia(Insert Dari)

What is Anesthesia?

Is the provision of a combination of amnesia, analgesia (pain control), and muscle relaxation to allow the performance of surgery or interventional procedures.

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General Anesthetics(Insert Dari)

General anesthesia is appropriate for most complex surgical procedures.

It can be divided into three distinct phases: induction, maintenance, and emergence. Different medications are used at different stages.

Mechanism of Action

Block the transmission of nerve impulses, and the release of neurotranmitters, this prevents muscle movement and pain sensation during procedures.

Other medications used cause the patient to go to sleep.

General anesthetics affect the entire nervous system.

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Nerve Synapse (Insert Dari) (1) The nerve impulse

travels from the dendrites through the cell body and down the axon.

(2) When the impulse reaches the axon it releases a chemical called a neurotransmitter.

(3) The neurotransmitter then crosses the synapse and binds to a receptor on the dendrite of the next neuron in order to transfer the signal.

Note: The synapse is a site of action for various medications.

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Nerve Synapse (Insert Dari) (Insert Dari)

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General Anesthetics(Insert Dari)

Side EffectsThese are side effects that occur once the patients wakes up:

Feeling sick to your stomach (nausea) and throwing up (vomiting) – Your doctor can give you medicines for this problem.

A sore throat – This can happen if you had a breathing tube. It usually gets better soon

Important Points

These medications are administered intravenously.

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Local Anesthetics(Insert Dari)

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Local Anesthetic(Insert Dari)

This type of anesthesia uses medicine to numb a small part of the body so the person cannot feel pain.

It can be given as a cream, gel, or spray on the skin. It can also be given by an injection (shot) into the skin.

You might be awake when you get local anesthesia.

Local anesthetics only affect the immediate area into which they are injected.

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Local Anesthetic (Insert Dari)

Mechanism of Action

Blocks both the start and transmission of nerve impulses.

It makes it more difficult for the nerve to generate the electrical impulse needed to transmit the message.

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Local Anesthetic

(Insert Dari)Indication

To perform minor procedures that would likely cause the patient to be in too much pain to remain still (i.e. would repair, dental work).

Side Effects

Irritation at the injection siteRare allergic reaction

Efficacy Lidocaine works in approximately 5 to 10 minutes and lasts approximately 30 min to 2 hrs in some people. Bupivacaine has the some onset of action but can last up to 6 hrs.

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Analgesics(Insert Dari)

OpioidsNon-opioid analgesicsAnti-migraine preparations

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Analgesia(Insert Dari)

Analgesia = Pain

Pain is an unpleasant sensory (sensations sent by nerves) and unpleasant emotional experience associated with actual or potential tissue damage.

Acute pain is pain that occurs due to an injury or tissue damage.

Chronic pain is pain that lasts longer than 3 months. In many cases, this means that pain continues even after the injury or condition that first caused it has been treated.

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The WHO Pain LadderStepwise approach to pain management.

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The goal is to use an appropriate medication to maximize pain control and minimize side effects.

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Opioids(Insert Dari)

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Mechanism of Action

Opioids alter the perception of pain and response to pain.

They do this by affecting the nerve pathways for pain transmission in the body.

All narcotics work on the same chemical process in the body, but they do it in different ways.

Some of these medicines are made from a plant called the poppy plant. There are also many man-made (also called synthetic) versions of narcotic pain medicines.

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Opioids(Insert Dari)Indications

• For treatment of moderate to severe, acute and chronic pain.

• Can also be used to calm a very severe cough.

• Can be used to treat pain after surgery.

• Some narcotics need to be taken more often during the day than others to work for certain kinds of pain.

Opioid Strength (most potent to least potent):

1.Morphine2.Codeine3.Pethidine (Meperidine) 4.Tramadol

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Efficacy The onset of effect and duration of effect vary

for each of the different opioids.

Side EffectsSome opioids are more likely than others to

cause certain side effects.• Feeling sleepy.• Dizziness.• Dry mouth.• Upset stomach or throwing up.• Hard stools (constipation).• Headache• Weakness

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Important Points• To gain the most benefit, instruct patients to not miss doses.

• Patients should take this drug at the same time(s) each day.

• Patients should drink lots of fluids and eat food high in fibre to prevent constipation while taking this medication.

• Pregnant patients should speak with a pharmacist prior to taking an opioid as there are risks involved for the baby.

• Taking narcotics to manage pain or other symptoms does not lead to addiction in most people. But it can be a problem for people who have problems with drug or alcohol use previously.

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Other Analgesics(Insert Dari)

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Non-Opioid Analgesics (Insert Dari)

Mechanism of Action

Paracetamol – blocks peripheral nerve pain transmission.

Also decreases fever.

Aspirin - similar to an NSAID and has analgesic properties.

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Non-Opioid Analgesics (Insert Dari)Indications

Paracetamol (Acetaminophen)

It is used to ease pain and fever

Aspirin• It is used to stop heart attacks.• It is used to stop strokes.• It is used to ease pain, swelling,

and fever.• It is used to treat arthritis.• 1It is used to treat gout attacks.• It is used to treat rheumatic fever.• It is used to protect bypass grafts

and stents in the heart.

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Side Effects

Paracetamol (acetaminophen)

• Fairly well tolerated

• May cause GI upset

• Rarely causes liver problems

Aspirin

• Belly pain or heartburn.

• Upset stomach or throwing up.

• Bleeding problems.

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Important Points

• Do NOT take other products containing aspirin or paracetamol.

• Aspirin should NOT be given to children or pregnant women.

• Acetaminophen is safe for both children and pregnant women.

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Antimigraine Preparations(Insert Dari)

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Migraine(Insert Dari)

Migraine is a chronic disorder characterized by recurrent moderate to severe headaches. Other symptoms include sensitivity to light as well as nausea and vomiting.

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Mechanism of ActionConstricts cranial blood vessels

and release neurotransmitters. Both help to decrease migraine.

IndicationsTo stop severe headaches

(migraines).

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Side Effects

• Feeling lightheaded, sleepy, having blurred eyesight, or a change in thinking clearly.

• Feeling dizzy. Rise slowly over a few minutes when sitting or lying down.

• Dry mouth.

• Muscle pain.

• Muscle weakness.

• Upset stomach.

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Important Points

• If a patient has been taking this medication for a long time and they stop taking it, it can cause rebound headaches.

• Overuse of this medication can also cause an increase in number of headaches.

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Antiepileptics(Insert Dari)

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Epilepsy (Insert Dari)

Epilepsy is a condition that causes people to have repeated seizures. Seizures are caused by abnormal electrical activity in the brain.

Seizures can make you pass out, or move or behave strangely.

Epilepsy can start at any age.

Epilepsy is treated with anti-seizure medicines. These medicines can’t cure epilepsy, but they can help prevent seizures

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Antiepileptics (Insert Dari)

Mechanism of ActionAntiepileptics work to restore the normal electrical activity in the brain.

They do this by affecting the electrical impulses of the neurons in the brain.

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Serious Side Effects

•An increased risk of becoming suicidal.

•A rare but serious skin disorder called Stevens-Johnson syndrome, which can cause fever and a painful, sometimes blistering rash. Most likely to occur with carbamazepine and phenytoin.

•A weakening of the bones (osteoporosis). This can occur after long-term use of anti-seizure medications

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Common Side Effects

• Dizziness.

• Feeling sleepy.

• Change in balance.

• Upset stomach or throwing up.

• Dry mouth.

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Anitepileptics(Insert Dari)

Important Points

• Avoid driving when you first start this medication.

• Do not switch brands or types of this drug.

• Take this medication regularly

• Do not run out of this medication.

• Many drug interactions exist, therefore it is important that a pharmacist speak to the patient .

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Psycholeptics(Insert Dari)

AntipsychoticsAnxiolyticsHypnotics and Sedatives

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Antipsychotics(Insert Dari)

Mechanism of ActionAffects the functioning of neurons in

the brain.

Indication

• It is used to treat problems with how one acts.

• It is used to treat mood problems.

Should NOT be used to treat dementia (decrease in cognitive function to aging) in the elderly.

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Side Effects• Dizziness.• Feeling sleepy.• Nervous and excitable.• Hard stools (constipation).• Dry mouth.• Upset stomach.• Loose stools (diarrhea).• Headache.• Not hungry.• Restlessness.• Not able to sleep.• Can cause weight gain.

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Important Points• Can be administered by injection

to treat acute behaviour problems. • Can be taken orally to treat on-

going behavioural problems. • Take medication regularly.

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Anxiolytics, Hypnotics and Sedatives(Insert Dari)

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Anxiolytics, Hypnotics and Sedatives: Benzodiazepines(Insert Dari)

Mechanism of Action Works to stabilize the neurons in the brain

making them less excitable which causes a relaxed state.

Indications

• Used to treat anxiety and panic attacks.

• Can be used to treat sleep problems

• Can be used to treat seizures

• Can be used to calm a patient before care (i.e. dental work).

• Can be used to treat addictions to other medications (diazepam).

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Anxiolytics, Hypnotics and Sedatives: Benzodiazepines(Insert Dari)

Side Effects• Drowsiness• Dry mouth • Change in balance

Important Points• Can be administered orally or by

injection. • Each medication has a different time to

take effect – i.e. lorazepam works much quicker than diazepam and diazepam will last much longer in the body.

• Patients should not drive after taking these medications.

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Psychoanaleptics(Insert Dari)

AntidepressantsAntidementia drugs

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What is depression?(Insert Dari)

Depression is a brain disorder that makes you sad, but it is different than normal sadness.

Depression can make it hard for you to work, study, or do everyday tasks.

Depressed people feel down most of the time for at least 2 weeks. They also have at least 1 of these 2 symptoms:

(1) They no longer enjoy or care about doing the things they used to like to do.(2) They feel sad, down, hopeless, or cranky most of the day, almost every day.

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What is anxiety? (Insert Dari)

Everyone feels anxious or nervous once in a while. That is normal. But being extremely anxious or worried on most days for 6 months or longer is not normal.

People with extreme or severe anxiety feel very worried much of the time. They can have trouble sleeping or forget things. Plus, they can have physical symptoms. For instance, people with severe anxiety often feel very tired and have tense muscles. Some even get stomach aches or feel chest “tightness.”

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Antidepressants(Insert Dari)

Mechanism of ActionEach of the antidepressants

works in a different way. But in general, they all affect the release and breakdown of neurotransmitters in the brain.

Indication

To treat depression or anxiety.

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Side Effects

• Feeling jittery or restless

• Having trouble sleeping

• Feeling tired

• Headaches

• Nausea or diarrhea

• Problems with sex

• Weight gain

These side occur at different levels with different antidepressants.

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Important Points

• Many people who take medicines start to feel better within 2 weeks, but it might be 4 to 8 weeks before the medicine has its full effect.

• Side effects tend to occur soon after starting this medication and generally decrease in severity over time.

• Very important that this medication is taken regularly.

• Different antidepressants work differently for different people. Patients may have to try a couple different ones before they find one that works.

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What is Dimentia?(Insert Dari)

Dementia – a decrease in memory, attention, problem solving, decision making and understanding.

This is due to aging and neuron degeneration and commonly occurs in the elderly.

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Anti-dimentia drugs: Piracetam(Insert Dari)

Mechanism of ActionImproves the function of certain

neurotransmitters.

IndicationsOnce thought to be effective for

improving cognition in dementia patients, the evidence is now seen as too inconsistent to support the use of piracetam for dimentia.

Now primarily used for myoclonus – which is unintended twitching of the muscles.

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Anti-dimentia drugs: Piracetam(Insert Dari)

Side Effects Symptoms of general

excitability, including anxiety, insomnia, irritability, headache, agitation, nervousness, and tremor, are occasionally reported

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Other Nervous System Drugs(Insert Dari)

ParasympathomimeticsAnti-vertigo preparations

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Neostigmine(Insert Dari)

Mechanism of ActionPrevents destruction of the

neurotransmitter that stimulates muscle movement.

Indications

• It is used to treat myasthenia gravis (a disease that causes muscle fatigue and weakness.

• It is used to get back function in muscles after surgery

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Neostigmine(Insert Dari)

Side Effects

• Belly pain

• Upset stomach

• Diarrhea

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Antivertigo Preparations: Cinnarizine(Insert Dari)

Mechanism of Action

Functions as an antihistamine.

Indication

Motion sickness – nausea and vomiting due to actual or perceived motion.

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Antivertigo Preparations: Cinnarizine(Insert Dari)

Side Effects• Very sedating, makes

patients feel quite drowsy. • Blurred vision • Dry mouth

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Questions?(Insert Dari)

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In-class Assignment(Insert Dari)

This assignment will consist of 7 questions which are to be completed individually. Once complete the instructor will review the answers with the class.

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1. Which of the following is INCORRECT regarding anesthesia?

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A) Is the provision of a combination of amnesia, analgesia (pain control), and muscle relaxation.

B) General anesthesia is used for minor procedures and local anesthesia is used for more complex procedures.

C) When a patient is awoken from general anesthesia they may feel nauseated and have a sore throat.

D) Local anesthetic is generally injected into the skin.

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1. Answer: Which of the following is INCORRECT regarding anesthesia?

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A) Is the provision of a combination of amnesia, analgesia (pain control), and muscle relaxation.

B) General anesthesia is used for minor procedures and local anesthesia is used for more complex procedures.

C) When a patient is awoken from general anesthesia they may feel nauseated and have a sore throat.

D) Local anesthetic is generally injected into the skin.

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2. Which of the following is NOT a side effect of opioids? (Insert Dari)

A) Diarrhea

B) Constipation

C) Upset stomach

D) Tiredness

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2. Answer: Which of the following is NOT a side effect of opioids?

(Insert Dari)

A) Diarrhea

B) Constipation

C) Upset stomach

D) Tiredness

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3. Which of the following is a safe analgesic option for both women and children?

A) Aspirin

B) Codeine

C) Paracetamol/Acetaminophen

D) Ibuprofen

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3. Answer: Which of the following is a safe analgesic option for both women and children?

A) Aspirin

B) Codeine

C) Paracetamol/Acetaminophen

D) Ibuprofen

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4. Match the following drugs with their class? (Insert Dari)

A) Ergotamine

B) Morphine

C) Lidocaine

D) Fluoxetine

1) Antidepressant

2) Local anesthetic

3) Opioid

4) Antimigraine

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4. Answer: Match the following drugs with their class? (Insert Dari)

A) Ergotamine (4) antimigraine

B) Morphine (3) opioid

C) Lidocaine (2) local anesthetic

D) Fluoxetine (1) antidepressant

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5. All antidepressants work the same for each person, True or False?

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5. All antidepressants work the same for each person, True or False?

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Answer: False(Insert Dari)

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6. Which of the following is used to treat muscle weakness?(Insert Dari)

A) Neostigmine

B) Carbamazepine

C) Haloperidol

D) Morphine

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6. Answer: Which of the following is used to treat muscle weakness?

(Insert Dari)

A) Neostigmine

B) Carbamazepine

C) Haloperidol

D) Morphine

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7. Which of the following is the major side effect of Cinnarizine?(Insert Dari)

A) Skin reaction

B) Sedation

C) Upset stomach

D) Severe diarrhea

afams nervous system drugs (insert dari) eo 003.01 part 29

Documents

local anesthesia

nerve synapse

pharmacy technicianinsert

entire nervous system

transmission of nerve

nerve impulse travels

atc system

different medications