| Clsses of Medications for Treating CNS Disorders: | 1. Analgesics
a. Opioids/Narcotics
b. NSAIDs (nonsteroidal anti-
inflammatory drugs) and
acetaminophen
2. Antiseizure/antiepileptic agents
3. Medications for neurodegenerative disorders
4. Muscle relaxants
5. Local anesthetics |
| In the narcotic drug class, medications are defined pharmacologically as? | agonists and antagonists. |
| Is a chemical (drug) that binds to a cellular receptor and activatesa response;
mimic the actions of endogenous opioid ligasnds. | Agonist |
| Is a borad term used to describe medications that provide pain relief. | Analgesics |
| The primary classes of analgesics are: | narcotics or opioids, which include narcotic agonist-antagonist drugs; NSAIDs, including salicylates and COX-2 inhibitors. |
| Other medications, such as gabapentin, an antiepileptic agent, are used to relieve pain (primarily neurologic pain), but these are not routinely classified as analgesics because | pain relief is a useful coincidental effect of their activity. |
| opiates (opioids) comprises a variety of chemicals that owe
their name to their derivative from the | poppy Palaver
Somniferous, also called the opium poppy. |
| classifications of opioids: | • a. natural opioids
• b. Semi- synthetic opioids
• c. Synthetic opioids
• d. Endogenous opioids |
| classifications of opioids: - are created from opiate alkaloids extracted
from the resin of the opium poppy. Ex: morphine or codeine | • a. natural opioids |
| classifications of opioids: - are produced chemically by altering
the natural opioids or morphine esters. Ex: oxycodone and
hydromorphone. | • b. Semi- synthetic opioids |
| classifications of opioids: – are derived from non-opioid substances
in laboratories. ex: meperidine, fentanyl and methadone. | • c. Synthetic opioids |
| classifications of opioids: - are created naturally by the body and
include substances called endorphins. | • d. Endogenous opioids |
| Opioids work by “agonizing” ???, which are found
in the brain, spinal cord, and gastrointestinal tract. This
binding action blocks transmission of nerve impulses. | opioid receptors |
| Opiate receptors are also responsible for some ???.
They may cause fluctuation in body temperature or alter heart rate and respiratory function. | autonomic function |
| Opiate receptors influence the? | neurotransmitters acetylcholine, dopamine, serotonin, and norepinephrine. |
| Neurotransmitters influenced by the opiate receptors cause the sensation of?, that patients experience when medications such as morphine and hydrocodone bind to opiate receptors in the brain. | well-being and euphoria |
| are necessary for the supraspinal analgesic effects from narcotics; they are also
responsible for the feelings of euphoria associated with opioid use, respiratory depression with
overuse, and opioid dependence. | Mu receptors |
| are responsible for enabling the body to experience pain relief. They also permit
the medication or natural neurotransmitters to exert an antidepressant effect and play a role in a
person’s physical addiction to opiates. | • Delta receptors |
| control appetite stimulation and are responsible for the formation of
depressive conditions and anxiety disorders. | • Nociceptin receptors |
| when total sedation is required in anesthesia, are also responsible for the pupil
constriction (miosis) seen in patients taking opiates. | • Kappa |
| Narcotics dull the sense of ??? and cause ???. They are effective in relieving severe pain and are used ??? to reduce anxiety and induce anesthesia. | Narcotics dull the sense of... pain;
and cause... drowsiness or sleep.
and are used... preoperatively |
| Narcotics are used to suppress cough through ??? due to their direct actions on the intestines, in instances where these
symptoms are not relieved by other medications. | direct action on the cough center in the medulla, and in
severe cases of diarrhea, |
| Caution should be exercised, however: In large doses, these medications can suppress the ability
to? | breathe and cause coma and death. |
| True or false: Narcotics should be taken with other drugs that depress the CNS | False
Narcotic drugs depress the CNS, they
should not be taken with other drugs
that depress the CNS, such as alcohol,
barbiturates, and benzodiazepines. |
| Opioids are metabolized by the ???, so
individuals with disease or damage in this organ
may not metabolize and eliminate these
medications as readily as healthy
individuals, which can then potentially
lead to accidental overdose. | liver, |
| Side effects of opioids include: drowsiness,
dizziness, confusion, sedation, euphoria,
insomnia, seizures, heart palpitations,
bradycardia, tachycardia, cardiac arrest,
nausea, vomiting, constipation, urinary
retention, rash, skin flushing, pruritus,
respiratory depression, and apnea. | drowsiness, dizziness, confusion,
sedation, euphoria, insomnia,
seizures, heart palpitations, bradycardia,
tachycardia, cardiac arrest, nausea, vomiting, constipation, urinary retention, rash, skin flushing, pruritus, respiratory depression, and apnea. |
| Nursing Process: Assessment: 1 | Assess patient regarding various aspects of pain such as its location, type, and character, utilizing pain scoring methods such as having the patient rate the pain. |
| Nursing Process: Assessment: 2: | The patient should not be required to wait too long between doses of analgesic medication. It is important to maintain adequate pain control. |
| Nursing Process: Assessment: 3 | Constipation is common with narcotic use, so provide stimulant laxatives as needed. |
| Nursing Process: Assessment: 4: | Obtain baseline vital signs and monitor blood pressure, pulse, and respirations closely. Watch the patient's intake and outputs closely. Decreases in output could indicate urinary retention. |
| Nursing Process: Assessment: 5: | Regularly check the patient for signs of adverse reactions and CNS changes such as dizziness, hallucinations, euphoria, or pinpoint pupils. |
| Nursing Process: Administration: 1: | Follow all guidelines for the proper storage of each medication. |
| Nursing Process: Administration: 2: | Be sure to provide safety measures such as side rails, a night light, a clutter-free room, and a call bell and water within easy reach. |
| Nursing Process: Administration: 3: | Assist the patient with ambulation or other activities as needed. |
| Nursing Process: Administration: 4: | When the patient has been on a long-term regimen of narcotics, withdrawal of these drugs should be gradual to avoid adverse reactions. |
| Nursing process: Overdose: Symptoms include: | decreased level of consciousness, pinpoint pupils, changes in heart rate, or decreased or absent respirations.
Cyanotic lips and nails are caused by decreased oxygen in the blood as an indirect result of depressed respiratory rate. |
| Reduce inflammation but are not related by structure or action to steroids (glucocorticoids), which also reduce inflammation. | NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) |
| The NSAID class of drugs provides both? | analgesic and antipyretic effects |
| NSAIDs work by? | reducing the production of prostaglandins |
| Are chemicals produced by the body that promote inflammation, pain, and fever | Prostaglandins |
| Prostaglandins protect the:
and promote: | Prostaglandins protect the lining of the stomach and intestines from the damaging effects of acid and;
promote blood clotting by activating blood platelets |
| NSAIDs are used for treating conditions that cause | inflammation, mild to moderate pain, and
fever. Examples include headaches, coughs and colds, physical injuries, gout, arthritis, menstrual
cramps, and postoperative discomfort. |
| blocks COX-2 but has little effect on COX-1.
Therefore, is subclassified as a selective COX-2 inhibitor, which causes fewer instances of gastrointestinal bleeding or ulceration than other NSAIDs.
This agent is used for the treatment of osteoarthritis, rheumatoid arthritis, acute pain, ankylosing spondylitis, and primary dysmenorrhea. | Celecoxib |
| The enzymes that produce prostaglandins are called | cyclooxygenases (COX). |
| NSAIDs block ??? by which reduce production of prostaglandins.
Therefore, inflammation, pain, and fever are reduced. Because the prostaglandins that protect the stomach and promote blood clotting also are reduced. | COX enzymes |
| Two types of COX enzymes are distinguished: | COX-1 and COX-2. |
| is chemically similar to acetylsalicylic acid (ASA, or aspirin) and functions in a comparable way, minimizing the production of prostaglandins. | Ibuprofen |
| is the only NSAID able to irreversibly inhibit COX-1; it is also indicated for inhibition of
platelet aggregation because it inhibits the action of thromboxane A2. This agent is useful in the
management of arterial thrombus and prevention of adverse cardiovascular events. | Aspirin |
| is commonly used for headaches and menstrual pain; it is especially effective as an anti-inflammatory agent. For arthritis, sprains, and other inflammation-based pain.
appears to be superior to ibuprofen in that it better targets muscle-tissue inflammation and has less of an anti-platelet effect than aspirin.
Dosing interval is longer (every 8-12 hours) than for other NSAIDs usually dosed for 4-6 hours. | Naproxen |
| is a very potent NSAID that is used for short-term management of moderately severe, acute pain that would normally be treated with narcotics, such as kidney stone pain or postsurgical pain.
It is more effective than other NSAIDs in reducing pain from both inflammatory and non-
inflammatory causes. This agent acts by reducing the production of prostaglandins by binding to the COX-1 and COX-2 enzymes, thus reducing pain and inflammation as well as their signs and
symptoms.
is not to be used for more than five days due to adverse effects on the kidneys; it also
causes ulcers more frequently than other NSAIDs. | Ketorolac |
| is an analgesic and antipyretic, but it is not an anti-inflammatory substance.
blocks pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis, so it does not have anti-inflammatory properties.
Its antipyretic action results from inhibition of prostaglandin synthesis in the CNS at the hypothalamic heat-regulating center.
While this has milder effects on the upper digestive tract than other over-the counter pain relievers, it can have serious side effects in cases of overdose or long-term therapy such as
renal failure and hepatic toxicity.
This agent should be used with caution in patients who have renal or hepatic disease and should
not be taken with alcohol.
does not decrease platelet aggregation and, therefore, is less likely to affect clotting capacity, which makes it a safer choice for hemophiliacs, patients taking “blood thinners,”
and for children.
It is often used as a first-line medication in conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. | Acetaminophen |
