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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