NERVOUS SYSTEM

1.CNS
BRAIN
SPINAL CORD
• Regulates body
function
• Interprets
information sent by
impulses from the
peripheral nervous
system
• C 1-2- breathing, neck flexor
• C3 & above : diaphragm function
• C4 : biceps and shoulders, but weaker
• C5 : use of shoulders and biceps, but not of
the wrists or hands.
• C6 : wrist control, no hand function.
• C7 and T1 : straighten their arms
• C7 is generally the level for functional
independence.
• T1 to T8 : control of the hands, but lack
control of the abdominal muscles
• T9 to T12 : Allows good trunk and abdominal
muscle control, and sitting balance is very
good.
• lumbar or sacral region of the spinal canal
are decreased control of the legs and hips,
urinary system, bowel and anus.
 2. PNS
SOMATIC NERVOUS AUTONOMIC NERVOUS
SYSTEM SYSTEM
(Visceral system)
Sympathetic Nervous system
Parasympathetic Nervous
system
• Involuntary
• Voluntary • Control and regulates
function of:
Heart
• Acts on skeletal muscles 
produce locomotion and Respiratory system
respiration GIT system
Glands
 ANS
Sympathetic Nervous Parasympathetic
System Nervous System
• Adrenergic system • Cholinergic system
• Neurotransmitter  • Neurotransmitter
norepinephrine acetylcholine
• Response  • Response 
excitability inhibition
• “Fight or Flight” 
stress
drugs affecting the autonomic
nervous system
 ADRENERGIC DRUGS
Sympathomimetics
• Stimulates the SNS
• mimics the action of the SNS
• Stimulation of SNS causes:
– Increase heart rate
– Dilation of the bronchioles and pupils
– Constriction of blood vessels
– Relaxation of muscles of:
• GIT
• Bladder
• Uterus
 ADRENERGIC DRUGS
Sympathomimetics

Stimulates the following receptor

Alpha-adrenergic

Beta adrenergic

Dopaminergic
 ADRENERGICS
sympathomimetics drugs
Alpha 1-adrenergic Receptors Alpha 2 – adrenergic receptor
Found in blood vessels Found in blood vessels
Activation results in Inhibits release of
vasoconstriction resulting in: norephineprine
Increase in BP Activation results in
Increase contractility of Vasodilation resulting in:
the heart Decreased BP
Contraction of bladder Decreased GI tone and
sphincter and prostate motility
capsule – increases
contraction and
ejaculation
Mydriasis – dilatation of
the pupil
Decrease salivary
secretions
 ADRENERGICS
sympathomimetics drugs
Beta 1 receptor Beta 2 receptors
• Found in the heart • Found in smooth
• Stimulation results in: muscles of lung,
– Increase myocardial arterioles of skeletal
contractility and uterine muscles
– Increase HR • Stimulation results in:
– Relaxation of smooth
muscle of lungs
bronchodilation
– Increase blood flow to
the skeletal muscle
– Relaxation of uterine
muscle decease uterine
contraction
 ADRENERGICS
sympathomimetics drugs
Classification
• Direct acting
– Directly stimulate the adrenergic receptor
• Epinephrine or norepinephrine
• Indirect acting
– Stimulates release of norepinephrine from
terminal endings
• Mixed acting
– Both direct and indirect acting
– Stimulates adrenergic receptor and stimulates
release of norepinephrine from terminal endings
 ADRENERGICS
sympathomimetics drugs
• Uses:
– Emergency drugs
– Given to treat:
• Cardiac arrest – stimulate the heart
• Hypotension – increase BP
• CHF – increase force of contraction of the heart
• Bronchial asthma – open the bronchioles
• Upper respiratory congestion – as decongestants
• Allergic reaction – for vasoconstriction
• Hypoglycemia – to stimulate glycogen release from liver
and skeletal muscles
• Local bleeding – constrict blood vessels
• OB – relaxes the uterus
• Eye disorder - mydriasis
 ADRENERGICS
sympathomimetics drug
Catecholamine group
Important drugs
• Route of
• Epinephrine – administration
Adrenaline – IM, SC
– Prototype of adrenergics – Inhalation
– Drug of choice for – Intra-cardiac
anaphylaxis
– Not given p.o. –
– Active ingredients in destroyed by GI
OTC asthma preparation enzymes
– Effects: stimulates both
alpha and beta receptors
• Increased BP, HR, blood
flow to the brain, heart,
and skeletal muscles
• Constrict peripheral
vessels
• Relaxes GI smooth
muscles
 ADRENERGICS
sympathomimetics drugs
Catecholamine group
Important drugs
• Norepinephrine – • Dopamine hydrochloride
Levophed – Intropin
– Immediate precursor of
– Potent vasoconstrictor
norepinephrine
– Indication : – Effects:
• Hypotension • Low dose – renal
• Cardiac arrest perfusion
• Low to moderate dose
– increased cardiac
output
• Higher dose –
increased peripheral
resistance and BP
 ADRENERGICS
sympathomimetics drugs
catecholamine group
• Dobutamine HCl – • Isoproterenol HCl -
Dobutrex Isuprel
– Synthetic catecholamine – synthetic catecholamine
– Acts directly on the – Bronchodilator
heart muscle  increase – Stimulates both beta 1
force of contraction and 2 receptors
– Control shock and some
dysrhytmias
– Route of administration –
parenteral and inhalation
 ADRENERGICS
sympathomimetics drugs
Catecholamine group
• Adverse Effect
– Nervousness and restlessness
– Angina
– hypertension
 ADRENERGICS
sympathomimetics drugs
Non-catecholamine group
• Ephedrine • Albuterol sulfate –
– Less potent Proventil, Salbutamol,
– Longer acting than Ventolin
epinephrine – Acts on Beta 2 receptor
– Used as bronchodilator – Produce bronchodilation
and nasal decongestant – Use for treatment of:
 in allergic reaction
• Bronchospasm
• Asthma
• Pseudoephedrine – Neo- • COPD
synephrine – Side effects
• Temors
• Dizziness
• Nervousness
• restlessness
 ADRENERGICS
sympathomimetics drugs
Non cathecholamine
• Adverse effect
– Palpitations
– Reflex tachycardia
– Hallucinations
– Cardiac dysrhythmias – life threathening
 ADRENERGICS
sympathomimetics drugs
Nursing Intervention
• Monitor:
– VS and ECG – increased HR, BP, dysrhythmias
– RR and lung sounds – bronchial congestion and dyspnea
– blood glucose level – increase
– I & O – urinary retention can result from high dose or
continuous used
• Avoid infiltration – necrosis – possible amputation of
extremity
– Inspect IV site every 15 minutes – edema and coolness
– Observed for decreased drip rate
– Discontinue infusion immediately
 ADRENERGICS
sympathomimetics drugs
Health Education
• Drugs pass into breast milk – avoid breast
feeding
• Continuous used of spray can result in
rebound nasal congestion
• Take as prescribe – avoid over dosage
• Avoid smoking or alcohol- precipitate adverse
effect
• IFI – 2-3l/day
• Correct way of inhalant
 Anti-Adrenergic Drugs
Adrenergic Blockers
Alpha-adrenergic – Uses:
blockers • Peripheral vascular
disease – Raynauds
– Blocks the effect of disease and frost
alpha recrptors bites
– Blocks • Confused elderly
sympathomimetics • Mild to moderate
agent hypertension
• Migraine
– Vasodilation in
• CHF
smooth muscle
• Pheochromocytoma –
– Lower peripheral tumor that release
vascular resistance excessive amount of
catecholamines
 Anti-Adrenergic Drugs
Adrenergic Blockers
Common Drugs
• Phentolamine mesylate – • Ergotamine tartrate –
Regitine • Ergostat
– Prototype – Vasoconstrictor
– Prevent tissue necrosis – Used to treat migraine
from infiltration of headache
norepinephrine
– Route of administration –
bitartrate (levophed)
SL, rectal suppository,
during IV therapy
inhalation
– Prevents and control
hypertension caused by
pheochromocytoma
 Anti-Adrenergic Drugs
Adrenergic Blockers
• Ergotamine tartrate • Prazosin (minipress)
with caffeine – • Terazosin (hytrin)
cafergot – Blocks post-synaptic
– Common anti- alpha 1 adrenergic
migrataine drug receptor
– Use for hypertension
 Anti-Adrenergic Drugs
Adrenergic Blockers
Beta-adrenergic blockers
• Blocks adrenergic stimulation
to beta 1 0r 2 receptors by
competing with norepinephrine
for available beta-adrenergic
receptor sites
• Block to beta 1 receptor cause
decrease:
– BP
– Contraction of the heart
muscle
– Cardiac output
• Block to beta 2 receptor cause
vasodilation in skeletal muscle
arterioles
• Use:
– Control angina pectoris –
decrease O2 demand,
myocardial contractility,
heart rate
– Lower BP
– MI – decrease incidence
of catecholamine-induced
dysrhythmias following
attack
– Glaucoma – reduce IOP
 decrease formation of
aqueous humor
– Migraine headache
 Anti-Adrenergic Drugs
Adrenergic Blockers
Beta-adrenergic blockers
Important drugs
• Propranolol HCl – inderal
– Prototype for beta-adrenergic blocking agents
• Metoprolol tartrate – lopressor
– For treatment of hypertension and dysrhythmias
• Atenolol – tenormin
– For hypertension, angina & MI
• Trimolol maleate – timoptic
– For treatment of glaucoma
 Anti-Adrenergic Drugs
Adrenergic Blockers
Ganglionic Blocking Agents
• stop the delivery of both sympathetic and
parasympathetic nerve impulse through ganglia
• Compete with acetylcholine to occupy receptor sites
in autonomic ganglia
• Act to decrease arterial pressure and lower BP
• Important drug: Mecamylamine HCl – inversine  the
only available ganglionic blockers currently available
• Uses:
– Advance stage of hypertension or hypertensive crisis
– Pulmonary edema
 drugs affecting the
parasympathetic nervous system
 Cholinergic agents
parasympathomimetics
cholinomimetics
• stimulate the PSNS
• Mimics the neurotransmitter acetlycholine
• 2 types of cholinergic receptors:
– Nicotinic : neuromuscular
• Action resembles effects of nicotine
– Tachycardia
– Elevated BP
– Peripheral vasoconstriction
– Muscarinic:
• Stimulate smooth muscle
• Slow heart rate
 Cholinergic agents
parasympathomimetics
cholinomimetics
EFFECTS • Genitourinary –
• Cardiovascular – contracts muscles of
vasodilation & slows urinary bladder
conduction of AV node – Increase tone of ureter
– Decrease HR – Relaxes bladder
– Low BP sphincter muscle
– Stimulates urination
• GIT –increases tone and
motility of smooth • Eye – increase pupillary
muscle of stomach and constriction or miosis 
intestine pupil smaller
– Increased peristalsis – Increase accomodation
– Relaxation of sphincter • Glands – increase
muscle salivation, perpiration
and tears
 Cholinergic agents
parasympathomimetics
cholinomimetics
• Lungs
– Stimulates bronchial smooth muscles
– Contraction and increases bronchial
secretions

• Striated muscles
– Increase neuromuscular transmission
– Maintains muscle strength and tone
 Cholinergic agents
parasympathomimetics
cholinomimetics
2 types – Specific Effects;
• Decreased heart rate
Direct Acting
• Increased:
Indirect Acting – Tone of GIT muscle
and relaxation of
• Direct Acting sphincters
cholinomimetic – Tone of bladder and
relaxation of
drugs sphincters
– Directly stimulate – Respiratory
cholinergic receptor secretions
• Constriction of pupil
– Mimic acetlycholine
Direct Acting Cholinergic Agents
Important drugs
• Bethanicol Cl –
urecholine
– Use for urinary retention
and atony  contracts
smooth muscle of
bladder
– For treatment of open
angle glaucoma
• Pilorcapine HCl –
pilocarpine
– Use to lower IOP in
glaucoma by constricting
the pupil
• Carbachol intraocular –
miostat
– Use to treat simple
glaucoma and open-angle
glaucoma
• Metoclopramide HCL –
Reglan
– Use to prevent
chemotherapy induced
nausea & vomiting
 Direct Acting Cholinergic Agent
USES ADVERSE EFFECT
• Glaucoma • N and V
• Postoperative atony • Diarrhea
• GI reflux disease • Wheezing and
• Neurogenic bladder shortness of breath
• Headache
• Increase salivation
• Increase sweat
• Poor night vision
• Sleep disturbance
• Convulsion & coma
Direct Acting Cholinergic Agent
PRECAUTIONS • Increase GI contraction
• Aggravate symptoms in and secretions in clients
persons with: with:
– DM – Intestinal obstruction
– MI • Monitor abdominal
distention, constipation,
– Gangrene diarrhea
– Heart block – Ulcerative colitis
• Monitor HR and rhythm – Peptic ulcer
• Report aching, burning
or epigastric pain
• Take before or after
eating meal
Direct Acting Cholinergic Agent
• Cause bronchial • when given
constriction and adrenergic agents –
increase bronchial increase risk of
secretions in: adverse effect
– Respiratory disorder – Have AtSO4 at hand
– Asthma – to counteract drug
• Monitor RR and interaction
breath sounds
 Indirect Acting Cholinergic
Agent
• Anti-cholinesterase
• Inhibits action of acetlycholinesterase
 enzyme that break down
acetylcholine
• Prolong the effect of acetlycholine
 Indirect Acting Cholinergic
Agent
IMPORTANT DRUGS • Edrophonium CL –
• Neostigmine bromide- tensilon
prostigmin – Use to diagnose
myasthenia gravis
– Use to treat urinary
retention and paralytic – Antidote for
ileus pancuronium – Pavulon – a
neuromuscular blocker
– Drug of choice in
treatment of myesthenia – Differentiate between
gravis  characterized Myesthenia crisis –
by neuromuscular resulting from under-
transmission dosage
accompanied by increase Chloinergic crisis –
weakness and fatigue of resulting from over-
skeletal muscle dosage
Indirect Acting Cholinergic Aent
• Pyridostigmine • AtSO4
bromide – mestinon – Use as antidote to
– The maintenance counteract adverse
drug of choice for effects of
myesthenia gravis cholinergic agents
 Indirect Acting Cholinergic
Agent
USES ADVERSE EFFECTS
• Myasthenia gravis – • Hypotension
improves muscle strength
• Glaucoma – reduces IOP • Miosis
• Post-op bladder distention – • Vasodilation
promotes bladder emptying
• Post-op paralytic ileus – • Intestinal spasm
increase intestinal muscle
tone
• N&V
• Counteract neuromuscular • Increase salivation
blockade – caused by muscle
relaxant employed for • Diaphoresis
anesthesia
 Indirect Acting Cholinergic
Agent
ADVERSE EFFECTS PRECAUTIONS
• Weakness and • Aggravate symptoms
muscular paralysis of:
• Paralysis of – DM
diaphragm – CAD
• Bronchial secretions – Ulcerative colitis
and spasm – Hypothyroidism
– Gangrene
• Respiratory arrest
– Heart block
 Indirect Acting Cholinergic
Agent
• Administered • not given with
cautiously to client ganglionic
with respiratory blocking agent
disorder or asthma
– Can cause severe
– increases bronchial
secretions hypotension
– Constrict smooth • Assess VS for
muscles of changes in HR and
bronchioles BP
• Monitor RR, increased
bronchial secretions,
diminished breath
sounds
 Indirect Acting Cholinergic
Agent
NURSING • Assess for signs of
INTERVENTIONS neurologic toxicity
• Assess S&S of – Tremor
myesthenia gravis – Restlessness
– Drooping of eyelids – Confusion
– Double vision – Convulsion
– Difficulty of chewing • Ensure client safety
and swalloeing
 Indirect Acting Cholinergic
Agent
• Assess abdominal HEALTH EDUCATION
cramps, vomiting, • Instruct client to:
diarrhea – Carry ID card at all
times - detail
medication regimen
– Take medication
exactly on time  to
prevent myasthenia
crisis or cholinergic
crisis
ANTICHOLINERGIC AGENT
• Also called muscarinic antagonist
• Blocks parasympathetic impulses by competing with
acetylcholine for sites on muscarinic receptors
• Depress CNS
• Affects :
– Skin
– Eyes
– GIT
– Bladder
– Bronchi
– HR
ANTICHOLINERGIC AGENT
IMPORTANT DRUGS • Trihexphenidyl –
• AtSO4 Artane
– Prototype – Use to treat
Parkinson’s disease
– Use:
• Treat bradycardia • Oxybutynin Cl –
• Antidote for Ditropan
cholinergic drug – Use in neurogenic
• Antidote for bladder
insecticide • Increase bladder
capacity
poisoning
• Decrease frequency
of voiding
ANTICHOLINERGIC AGENT
• Scopolamine ADVERSE EFFECT
hydrobromide – • Dryness of the
hyoscine mouth
– For treatment of – Use ice chips
motion sickness
– Good oral hygiene
– Management of N &
– Chew gum or hard
V with use of general
candy
anesthesia
– Produce pre- • Constipation
operative amnesia – Fluid intake – 8
cups/day
Drugs Affecting the CNS

a. CNS Stimulant

b. CNS Depressant
 A. CNS stimulant
• act to stimulate • Large doses
– Respiratory system – Produce insomnia,
– Heart tremors,
restlessness
– General metabolism
• Small doses • Toxic dose
– Produce convulsion
– Increase alertness
– Cardiac
– Impart feeling of
wellness dysrhythmias
– Possibly death
• Prolonged use
– Results in exhaustion
– Hypertension
 CNS STIMULANT
MAJOR GROUP
• Amphetamines, Amphetamine Like
Stimulates the cerebral cortex

• Analeptics and caffeine

Acts on brainstem and medulla
Stimulate respiration

• Anorexiants
Acts on cerebral cortex and hypothalamus
Suppress appetite
 CNS STIMULANT
A. Amphetamine & Amphetamine Like
• Stimulate release of neurotransmitters
Norepinephrine
Dopamine

• produce Euphoria and increased

alertness
 CNS STIMULANT
AMPHETAMINES
Common Drugs
c. Amphetamine sulfate (adderal)
d. Dextroamphetamine sulfate
(dexedrine)
e. mathamphetamine HCl (desoxyn)
 CNS STIMULANT
Amphetamine Like Drugs
Common Drugs
c. Methylphenidate HCl (ritalyn)
d. Modafinil (provigil)
e. Pemolyn (cylert)
 CNS STIMULANT
AMPHETAMINES
Indication
• Narcolepsy Alleviate attacks
• ADHD Decrease hyperactivity
• Endogenous obesity – obesity
resulting from dysfunction of
endocrine or metabolic system
Suppress appetite
 Amphetamine Like drugs

Indication

-consider more effective in treating

ADHD and NARCOLEPSY except
for adderal, but less Side
Effects
 Amphetamine & Amphetamine Like
Drugs
Side effects
• Tolerance, Dependence, Abuse
• Tachyphylaxis – decrease effectiveness
• Nervousness, irritability, Headache, Dizziness,
Insomnia
• Hypertension, palpitations
• Dry mouth
• Weight loss  prolonged used
• Taken 30 mins before meal
• C.I. with symphatomimetic drugs and pregnant
mother
 CNS STIMULANT
2. ANALEPTICS
• Beta adrenergic agonist

• Stimulate respiration

• Stimulate epinephrine the focus is to

dilate bronchioles
 CNS STIMULANT
ANALEPTICS
Common Drugs
• Methylxanthine
 Caffeine
 Theophylline
 theobromine
 CNS STIMULANT
ANALEPTICS
Indication
• COPD- chronic obstructive pulmonary
disease of the airway
• Bronchial Asthma
• Infant Abnormal Apnea
 ANALEPTICS
Side effects
• Tolerance, Dependence, Abuse
• Nervousness, irritability, Headache, Dizziness,
Insomnia
• diuresis
• tinnitus
• Weight loss  prolonged used
• C.I. with symphatomimetic drugs and pregnant
mother
 CNS STIMULANT
• ANOREXANTS

• Stimulate the appetite control center

in the hypothalamus for suppression

• Increase epinephrine w/ increase

euphoria, alertness and concentration
 CNS STIMULANT
Anorexants
Common Drugs
• Benzphetamine HCL (didrex)
• Dextroamphetamine Sulfate
(dexedrine)
• Dethylpropion HCl ( dospan, tenuate)
 CNS STIMULANT

ANOREXANTS
Indication
3. Overweight or obese person

5. Treat attention deficit

 Anorexants
Side effects
• Tolerance, Dependence, Abuse
• Nervousness, irritability, Headache, Dizziness,
Insomnia
• tinnitus
• Drug contain phenylpropanolamine
cause hemorrhagic stroke, HPN, cardiac
dysrhythmias
 B. CNS Depressant
• SEDATIVE- lessen the • Large doses
mental response but not
affect the consciousness in – Can suppress the
small amount respiratory center
• HYPNOTICS- to have a in medulla
restful natural sleep that – Skin rash/urticaria
allow the patient to awaken
at usual time • Prolonged use
• SEDATIVE-HYPNOTICS- – dependence
depressed the CNS
- calmness, relaxation,
– tolerance
reduction of anxiety, – Withdrawal
sleepiness syndrome once
- used also as anticonvulsant abruptly stop
 CNS DEPRESSANT
sedative-hypnotic
• It produces all levels of CNS
depression- depress the sensory cortex
decrease-motor activity-by Gamma-
aminobutyric acid (GABA) - chief
inhibitory neurotransmitter in the
mammalian CNS.
• - regulating neural excitability
throughout the nervous system.
Depress the activity of all excitable
tissue
• treat anxiety and sedate
 CNS DEPRESSANT
MAJOR GROUP
• Barbiturates
Depress all levels of CNS and sensory cortex

Benzodiazepine
Reduced Neuron excitability
significantly less dangerous in overdose

• Nonbenzodiazepine
Reduced Neuron excitability
 CNS DEPRESSANT
sedative-hypnotic
barbiturates
Classification
• Long-acting
• Immediate-acting
• Short-acting
• Ultrashort acting
 CNS DEPRESSANT
sedative-hypnotic
barbiturates
1. LONG-ACTING
Common drugs Indication
• Phenobarbital
(luminal) • Seizure in epilepsy
(anticonvulsant)
• Mephobarbital
(mebaral) • Insomnia
 CNS DEPRESSANT
sedative-hypnotic
barbiturates
2. IMMEDIATE-ACTING
Common drugs Indication
• Amobarbital(amytal) - insomnia
-preoperational meds
• Aprobarbital(alurate) - seizure in epilepsy
(anticonvulsant)
• Butabarbital (butisol)
 CNS DEPRESSANT
sedative-hypnotic
barbiturates
3. Short-Acting
Common drugs Indication
• Secobarbital - difficulty sleep at
(seconal) night (insomnia)
- more on elderly
• Pentobarbital
(nembutal)
 CNS DEPRESSANT
sedative-hypnotic
barbiturates
3. Short-Acting
Common drugs Indication

• Thiopental sodium • Used in operation as

(pentothal) general aesthetic
 CNS DEPRESSANT
sedative-hypnotic
barbiturates
• Side Effects
• Drowsiness, lethargy, vertigo, depression
• Hypotension and respiratory depression
• Phlebitis
• Produce dependence, tolerance, and
withdrawal symptoms if abruptly stop
• Hangover
• May overuse -addiction
 CNS DEPRESSANT
sedative-hypnotic
• Benzodiazepine

-stimulate GABA
-most widely used depressant
-less dangerous to overdose and addiction
 CNS DEPRESSANT
sedative-hypnotic
benzodiazepine
Common Drugs INDICATION
• Diazepam (Valium) -Anxiety, convulsion

• Triazolam (halcion) -hypnotic-insomnia

• Lorazepam (atevan) -seizure in epilepsy

• Aprezolam (xanax) -insomnia

 CNS DEPRESSANT
sedative-hypnotic
benzodiazepine
• Side Effects
• Drowsiness, morning hangover, blurred vision,
hypotension
• phlebitis
• Produce dependence, tolerance, and
withdrawal symptoms if stop abruptly
• But less addiction forming than barbiturates
 CNS DEPRESSANT
sedative-hypnotic

• Nonbenzodiazepine
-comparatively new drugs whose actions are
somewhat similar to those of the
benzodiazepines, but are structurally unrelated
to the Benzodiazepines.
 CNS DEPRESSANT
sedative-hypnotic
Nonbenzodiazepine

Common Drugs Indication

imidazopyridines
• Zolpidem (Ambien) -treatment of insomnia
-muscle relaxant
pyrazolopyrimidines -anticonvulsant
• zaleplon (Sonata)
 CNS DEPRESSANT
sedative-hypnotic
Nonbenzodiazepine

• Side Effect
• Drowsiness, lethargy, hangover, dizziness,
respiratory distress, confusion and
disorientation

• Tolerance and dependence-rare

 CNS Depressant
ANESTHESIA
• traditionally meant the condition of
having sensation blocked
• Use in surgery
• Is a reversible lack of awareness
- total lack of awareness
- lack of awareness of a part of the
body
 Assessment before giving
Anesthesia
1. The age especially the young and
elderly
2. A current health disorder (renal, liver
disease
3. pregnancy
4. History of heavy smoking, used of
alcohol and drugs
 ANESTHESIA
• Balance Anesthesia

3. The hypnotic drug-night before

4. Narcotic analgesic/Benzodiazepine and
anticholinergic- 1 hr before
5. Short-acting barbiturates
6. Inhaled gas such as nitrous oxide and
oxygen
7. Muscle relaxant (as needed)
 ANESTHESIA

• Stages of Anesthesia
Stage 1
ANALGESIA- consciousness---loss of
consciousness
Stage 2
EXCITEMENT/DELIRIUM- produce loss of
consciousness by depression of cerebral
cortex
 ANESTHESIA
• Stages of Anesthesia
Stage 3
SURGICAL- anesthesia deepen--- procedure
was performed– stage maintain

Stage 4
MEDULLARY PARALYSIS- toxic stage
 ANESTHESIA
CLASSIFICATION OF ANESTHESIA
• Local anesthesia
numbs a small part of the body.
• Regional anesthesia
• blocks pain to a larger part of your body.
• General anesthesia
• loss of consciousness during which patients
are not arousable, even by painful stimulation
 ANESTHESIA
• Local Anesthesia
-You get a shot of local anesthetic directly into
the surgical area to block pain

-prevent transmission of nerve impulses

without causing. They act by binding to fast
sodium channels from within

-patient might awake or may take anxiolytic or

hypnotic drug
 ANESTHESIA
Local Anesthesia
Common Drugs • Indication

• Cocaine • Use in minor and

hydrochloride diagnostic
procedure
• Procaine HCL
(Novocain) • Use in episiotomy
• Use also in dental
• Lidocaine HCL procedures
(Xylocaine)
 ANESTHESIA
• Regional Anesthesia
• Administered with local anesthesia to
peripheral nerve bundles
• Loss of pain sensation, with varying degrees
of muscle relaxation, in certain regions of
the body.
Types:
• Spinal anesthesia: subarachnoid block.
• Epidural anesthesia:
 ANESTHESIA
Regional anesthesia
A. Spinal Anesthesia (Subarachnoid block)

- small volume of local anesthetics being

injected into CSF the arachnoid mater,
injected between the 4th and 5th lumbar
vertebrae

- loss of pain sensation and muscle strength,

usually up to the level of the chest to toe
 ANESTHESIA
Spinal Anesthesia
Common Drugs Indication

• Bupivacaine -major surgical

(Marcaine) operation/ Special
procedure to diminish
2. Lignocaine sensation, loss of pain
(Lidocaine) and muscle relaxant
 ANESTHESIA
Regional anesthesia
B. Epidural Anesthesia
- injection of drugs through a catheter placed
into the epidural space outside the dura
mater
- The injection can cause both a loss of
sensation and a loss of pain by blocking the
transmission of signals through nerves in or
near the spinal cord.
 ANESTHESIA
Epidural Anesthesia
Common Drugs Indication
- combination of local
anesthetics and -major surgical
opioids operation/ Special
Ex. procedure to diminish
- Bupivacaine + sensation, loss of pain
morphine
- Choloprocaine +
Pethidine
 ANESTHESIA
• General Anesthesia
• Drug-induced depression of consciousness/
CNS

• Drug-induced loss of consciousness - not

arousable - even by painful stimulation

• administer intravenously or inhalation agents

 ANESTHESIA
General Anesthesia
Common Drugs Indication

• Halothane -major surgical

Operation attain
• Nitrous Oxide complete depression
of
• Sevoflurane consciousness to
diminish sensation,
loss
of pain and muscle
relaxant
 ANAESTHESIA

• Adverse Effect
- including agitation, confusion, dizziness, blurred
vision, tinnitus, a metallic taste in the mouth, and
nausea, body weakness
- amnesia, neurological disorder, seizure
- paralysis, respiratory and cardiac depression,
coma and even death
 Pathophysiology of Pain

tissue damage injured cells 

produce chemical mediators
(prostaglandins)  nocireceptor
(all types of tissue)  transmit
pain sensation  brain
 CNS Depressant
ANALGESIC
“pain killer- drugs used to relieve pain”
• Nonnarcotic Analgesic
 Acetaminophen/ NSAID
 COX-2 Inhibitor

• Narcotic Analgesic
 Opiates/ Morphinomimetics
 ANALGESIC
• Nonnarcotic Analgesic
- Used to treat mild to moderate pain

- Acts on peripheral nervous system at the

pain receptor site

- less potent than narcotic analgesic

- Not addictive / abusive

 ANALGESIC
Nonnarcotic Analgesic
Nonsteroidal Anti-inflammatory Drugs
- Relieve pain (Analgesic), fever (antipyretic)
and anti-inflammatory
- inhibit cyclooxygenase(COX1 & COX2),
leading to a decrease in prostaglandin
production; this reduces pain and also
inflammation
- COX1- protects stomach lining & regulate
blood platelets
- COX2- trigger pain and inflammation at site
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Common Medication
 COX1 & COX2 • Indication
inhibitor -headache, muscle
• Aspirin(Bayer,Ecotin, pain
Astrin) -pain from arthritis
-known NSAID not used
as antipyretic  effect -mild anticoagulants
Reye Syndrome for TIA, heart attack
- Decrease platelet thromboembolism
aggregation
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Side Effect • Contraindicated
(Aspirin) - Pregnant
- Gastric - Patient <12 years old
discomfort, - Patient with
- tinnitus, vertigo, bleeding
deafness - Patient taking
acetaminophen
- increase bleeding
- Alcoholic patient
- Allergic Reaction - Patient w/
hypersensitivity
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Indication
2. Mefenamic Acid - Relieved pain
(Istan, Revalan, from incision of
Dolfenal) operation
-new generation of - -headache, muscle
NSAID pain
- less cause G.I.
- toothache
irritant
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Side Effect • Contraindicated
(Mefenamic Acid) - G.I. problem, bleeding
(gastroenteritis)
- Gastric discomfort,
- Pregnant
- tinnitus, vertigo,
- Patient<12 years old
- Deafness - Patient w/ renal/hepatic
- Alergic reaction disease
- Patient taking
acetaminophen
- Hypersensitive patient
 ANALGESIC
Nonnarcotic Analgesic
NSAID
1. Ibuprofen (Advil, • Indication
Motrin, Midol, - headache, muscle
Excedrin) pain
-new generation of - Rheumatoid
NSAID Arthritis,
- less cause G.I. osteoarthritis
irritant
- toothache
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Side Effect • Contraindicated
(Ibuprofen) - G.I. problem, bleeding
- Gastric discomfort, (gastroenteritis)
- dyspepsia - Pregnant
- Nausea & vomitting - Patient w/ renal/
hepatic disease
- tinnitus
- Patient<12 years old
- Allergic reaction
- Patient taking aspirin
- G.I. bleeding- A.E
- Hypersensitive patient
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Common Medication • Indication
 COX2 inhibitor - Pain from
3. Celecoxib (celebrex) osteoarthritis,
rheumatoid
5. Meloxicam (Mobic) arthritis
- Patient with
7. Nabumetone surgical incision
(Rafalen)
 ANALGESIC
Nonnarcotic Analgesic
NSAID
• Side Effect • Contraindicated
(COX2 inhibitor) - Pregnant
- Patient <12 years old
- tinnitus, vertigo - Patient with allergy
- Patient taking
acetaminophen
- Allergic reaction - Hypersensitive
patient
 ANALGESIC
Nonnarcotic Analgesic
• ACETAMINOPHEN
- non narcotic, not NSAID
- weakly inhibits prostaglandin synthesis
- Inhibition of hypothalamic heat
regulator center
- from para aminophenol derivatives
- relieve pain, discomfort, and fever but
not anti-inflammatory effect
 ANALGESIC
Nonnarcotic Analgesic
• Common Drugs • Indication
• Acetaminophen - Moderate pain and
-(Tylenol, Panadol, headache
Tempra, robigesic, - Fever especially in
Atasol) children
- Muscular ache/pain
- Fever cause by viral
infection
 ANALGESIC
Nonnarcotic Analgesic
• Nursing Responsibility
• Side Effect
- Instruct the patient
- anorexia, n & v, rash
about the effect
- Don’t overdose and
• Adverse Effect over used
- Severe - Take the dose as
hypoglycemia, prescribe
oliguria, urticaria - Have rest
- Hepatotoxicity - Keep out of children
 ANALGESIC
• Narcotic Analgesic
- Used to treat moderate to severe pain

- Acts on central nervous system does produce

also little depression by binding directly to
opioid receptor in CNS and GI tract

- Suppress pain, respiration and

coughing(antitussive)

- addictive / abusive
 ANALGESIC
Narcotic Analgesic
• Common Drugs • Indication
2. Morphine Sulfate - Acute pain from
(Duramorph, MS acute myocardial
Cotin, Epimorph) infarction
-most potent -pain from cancer and
narcotic analgesic dyspnea
- suppress pain, - preoperative meds
respiration and
cough
 ANALGESIC
Narcotic Analgesic
2. Meperidine (Demerol) • Indication
- first synthetic - Preoperative
narcotics medication
- same action w/ - Sedation
Morphine, potency - More preferred to
varies on dosage given pregnant mother than
morphine
3. Hydromorphone
(Dilaudid) - Not given with
Advance cancer 
- Analgesic effect more
large dose 
potent than morphine
neurotoxicity
- Less resp. depression (nervousness, tremors,
irritability)
 ANALGESIC
Narcotic Analgesic
• Side Effect • Contraindicated
- Anorexia, N & V, -asthma w resp
dizziness, drowsiness, depression
urinary retention, - inc. ICP , shock,
constipation, euphoria head injury
• Adverse Effect - Renal and hepatic
disease/dysfunction
-resp. depression,
- M.I.
hypotension, increase
- Advance cancer 
ICP, seizure, large dose 
withdrawal syndrome neurotoxicity
 ANALGESIC
Narcotic Analgesic
• Nursing Responsibilities
- administer before pain reach its peak
- Monitor v/s (BP and RR) and urine output
(above 600ml/day)
- Increase fiber diet or laxative as order
- Check pinpoint pupils morphine/narcotic
overdose  naloxone(narcan) available
- Give the medication as prescribe
 ANALGESIC
Narcotic Agonist-Antagonist
• Common Drugs • Mechanism of Action
• Pentazocine (Talwin) • - Inhibit the pain
• Buprenorphine impulse transmitted
(Buprenex) in the CNS by binding
by the opiate
• Nalbuphine HCl receptor and
(Nubain) increase pain
- narcotic antagonist threshold
is added with a • Indication
narcotic agonist to
decrease abuse - Post operation meds
for pain
- Sedation, labor mom
 Narcotic Agonist Antagonist
• Side Effects • Nursing
- dizziness, confusion, Responsibility
sedation, dry mouth, - Monitor vital sign
nausea, flushing - let the patient void or
• Adverse Effect do things before
- tachycardia, giving
hypotension and - Don’t give anything
respiratory by mouth
depression
 Narcotic Antagonist
• Common Drugs • Indication
• Nalmefene (Revex) - Antidote for
overdose of narcotics
• Naloxone HCl -have higher affinity
(Narcan) to opiate receptor
does displace narcotic
• Naltrexone HCL Agent
(Trexan)
- Reverse CNS and
respiratory depression
 CNS Depressant
Anticonvulsant
• Drug use to treat epileptic seizure ‘antiepileptic’
• suppress the abnormal, rapid and excessive
firing of electrical impulses from cerebral
neurons that start a seizure
• Acts in 3 ways
- suppressing the sodium influx
- Suppressing the calcium influx
- Increasing the action of GABA
 CNS Depressant
Anticonvulsant
• Common Drugs • Side Effect
2. Hydantoins - Gingival hyperplasia or
(phenytoin (Dilantin), overgrowth of gum
mephenitoin ethotoin) tissue  bleed
- Most common drugs to - Neurologic or
control seizure (grand mal psychiatric effects 
seizure) slurred speech,
- Not used for all types of confusion, depression,
seizure
thrombocytopenia,
Leukopenia, n & v,
constipation, drowsiness
 CNS Depressant
Anticonvulsant
2. Barbiturates • Nursing Responsilities
Amobarbital (Amytal) - Take the medication as
Mephobarbital prescribe
Primodone (Mysoline) - Monitor serum drug
level
3. Benzodiazepine
- Patient receive
Clonazepam (Klonopin) adequate nutrients
Clorazepate (tranxene Decrease the
-
Diazepam (Valium) environmental stimulation
Lorazepam (Ativan) for active seizure