Transcript EO 003.01 - Part 28 - Nervous System Drugs

Nervous System Drugs
(Insert Dari)
EO 003.01 Part 29
AFAMS
Overview of Lesson
(Insert Dari)
Anesthetics
- General
- Local
Insert Dari
Analgesics
- Opioids
- Other analgesics and antipyretics
- Anti-migraine preparations
Antiepileptics
Psycholeptics
-Antipsychotics
-Anxiolytics
-Hypnotics and Sedatives
AFAMS
Overview of Lesson
(Insert Dari)
Psychoanaleptics
- Antidepressants
- Anti-dementia drugs
Insert Dari
Other nervous system drugs
- Parasympathomimetics
- Antivertigo preparations
AFAMS
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
Insert Dari
(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
AFAMS
AFAMS
AFAMS
AFAMS
AFAMS
Anesthetics
(Insert Dari)
AFAMS
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.
AFAMS
AFAMS
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.
AFAMS
(1) The nerve impulse
travels from the
dendrites through the
cell body and down the
axon.
Nerve Synapse
(Insert Dari)
(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.
AFAMS
(Insert Dari)
Nerve Synapse
(Insert Dari)
AFAMS
General Anesthetics
(Insert Dari)
Side Effects
These 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.
AFAMS
Local Anesthetics
(Insert Dari)
AFAMS
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.
AFAMS
AFAMS
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.
AFAMS
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 site
Rare 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.
AFAMS
Analgesics
(Insert Dari)
Opioids
Non-opioid analgesics
Anti-migraine preparations
Insert Dari
AFAMS
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.
AFAMS
The WHO Pain Ladder
Stepwise approach to pain management.
Insert Dari.
Insert Dari
Insert Dari
Insert Dari
Insert Dari
Insert Dari
The goal is to use an appropriate medication to maximize pain
control and minimize side effects.
Insert Dari
AFAMS
Opioids
(Insert Dari)
AFAMS
AFAMS
Opioids
(Insert Dari)
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.
AFAMS
Indications
Opioids
(Insert Dari)
• 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.
2.
3.
4.
Morphine
Codeine
Pethidine (Meperidine)
Tramadol
AFAMS
Opioids
(Insert Dari)
Efficacy
The onset of effect and duration of effect
vary for each of the different opioids.
Side Effects
Some 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
AFAMS
Opioids
(Insert Dari)
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.
AFAMS
Other Analgesics
(Insert Dari)
AFAMS
AFAMS
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.
AFAMS
Indications
Non-Opioid Analgesics
(Insert Dari)
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.
AFAMS
Non-Opioid Analgesics
(Insert Dari)
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.
AFAMS
Non-Opioid Analgesics
(Insert Dari)
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.
AFAMS
Antimigraine Preparations
(Insert Dari)
AFAMS
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.
AFAMS
AFAMS
Antimigraine Preparations
(Insert Dari)
Mechanism of Action
Constricts cranial blood vessels
and release neurotransmitters.
Both help to decrease migraine.
Indications
To stop severe headaches
(migraines).
AFAMS
Antimigraine Preparations
(Insert Dari)
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.
AFAMS
Antimigraine Preparations
(Insert Dari)
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.
AFAMS
Antiepileptics
(Insert Dari)
AFAMS
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 antiseizure medicines. These
medicines can’t cure epilepsy,
but they can help prevent
seizures
AFAMS
AFAMS
Antiepileptics
(Insert Dari)
Mechanism of Action
Antiepileptics work to restore the
normal electrical activity in the
brain.
They do this by affecting the
electrical impulses of the neurons
in the brain.
AFAMS
Antiepileptics
(Insert Dari)
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 antiseizure medications
AFAMS
Antiepileptics
(Insert Dari)
Common Side Effects
• Dizziness.
• Feeling sleepy.
• Change in balance.
• Upset stomach or throwing up.
• Dry mouth.
AFAMS
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 .
AFAMS
Psycholeptics
(Insert Dari)
Antipsychotics
Anxiolytics
Hypnotics and Sedatives
Insert Dari
AFAMS
AFAMS
Antipsychotics
(Insert Dari)
Mechanism of Action
Affects 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.
AFAMS
Antipsychotics
(Insert Dari)
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.
AFAMS
Antipsychotics
(Insert Dari)
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.
AFAMS
Anxiolytics, Hypnotics and Sedatives
(Insert Dari)
AFAMS
AFAMS
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).
AFAMS
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.
AFAMS
Psychoanaleptics
(Insert Dari)
Antidepressants
Antidementia drugs
Insert Dari
AFAMS
AFAMS
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.
AFAMS
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.”
AFAMS
Antidepressants
(Insert Dari)
Mechanism of Action
Each 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.
AFAMS
Antidepressants
(Insert Dari)
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.
AFAMS
Antidepressants
(Insert Dari)
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.
AFAMS
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.
AFAMS
AFAMS
Anti-dimentia drugs: Piracetam
(Insert Dari)
Mechanism of Action
Improves the function of
certain neurotransmitters.
Indications
Once 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.
AFAMS
Anti-dimentia drugs: Piracetam
(Insert Dari)
Side Effects
Symptoms of general
excitability, including anxiety,
insomnia, irritability, headache,
agitation, nervousness, and
tremor, are occasionally
reported
AFAMS
Other Nervous System Drugs
(Insert Dari)
Parasympathomimetics
Anti-vertigo preparations
Insert Dari
AFAMS
AFAMS
Neostigmine
(Insert Dari)
Mechanism of Action
Prevents 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
AFAMS
Neostigmine
(Insert Dari)
Side Effects
• Belly pain
• Upset stomach
• Diarrhea
AFAMS
AFAMS
Antivertigo Preparations: Cinnarizine
(Insert Dari)
Mechanism of Action
Functions as an antihistamine.
Indication
Motion sickness – nausea and
vomiting due to actual or
perceived motion.
AFAMS
Antivertigo Preparations: Cinnarizine
(Insert Dari)
Side Effects
• Very sedating, makes
patients feel quite drowsy.
• Blurred vision
• Dry mouth
AFAMS
Questions?
(Insert Dari)
AFAMS
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.
Insert Dari
AFAMS
1. Which of the following is INCORRECT regarding
anesthesia?
(Insert Dari)
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.
AFAMS
1. Answer: Which of the following is INCORRECT
regarding anesthesia?
(Insert Dari)
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.
AFAMS
2. Which of the following is NOT a side effect of opioids?
(Insert Dari)
A)
B)
C)
D)
Diarrhea
Constipation
Upset stomach
Tiredness
AFAMS
2. Answer: Which of the following is NOT a side effect of
opioids?
(Insert Dari)
A)
B)
C)
D)
Diarrhea
Constipation
Upset stomach
Tiredness
AFAMS
3. Which of the following is a safe analgesic option for both
women and children?
A)
B)
C)
D)
Aspirin
Codeine
Paracetamol/Acetaminophen
Ibuprofen
AFAMS
3. Answer: Which of the following is a safe analgesic
option for both women and children?
A)
B)
C)
D)
Aspirin
Codeine
Paracetamol/Acetaminophen
Ibuprofen
AFAMS
4. Match the following drugs with their class?
(Insert Dari)
A)
B)
C)
D)
Ergotamine
Morphine
Lidocaine
Fluoxetine
1)
2)
3)
4)
Antidepressant
Local anesthetic
Opioid
Antimigraine
AFAMS
4. Answer: Match the following drugs with their class?
(Insert Dari)
A)
B)
C)
D)
Ergotamine (4) antimigraine
Morphine (3) opioid
Lidocaine (2) local anesthetic
Fluoxetine (1) antidepressant
AFAMS
5. All antidepressants work the same for each person, True
or False?
(Insert Dari)
AFAMS
5. All antidepressants work the same for each person, True
or False?
(Insert Dari)
Answer: False
(Insert Dari)
AFAMS
6. Which of the following is used to treat muscle weakness?
(Insert Dari)
A)
B)
C)
D)
Neostigmine
Carbamazepine
Haloperidol
Morphine
AFAMS
6. Answer: Which of the following is used to treat muscle
weakness?
(Insert Dari)
A)
B)
C)
D)
Neostigmine
Carbamazepine
Haloperidol
Morphine
AFAMS
7. Which of the following is the major side effect of
Cinnarizine?
(Insert Dari)
A)
B)
C)
D)
Skin reaction
Sedation
Upset stomach
Severe diarrhea
AFAMS
7. Which of the following is the major side effect of
Cinnarizine?
(Insert Dari)
A)
B)
C)
D)
Skin reaction
Sedation
Upset stomach
Severe diarrhea
AFAMS