NURSING PHARMACOLOGY DAY 2 GASTROINTESTINAL DRUGS - Entir Entire e GI tract tract is is unst unsteri erile le – with with nor normal mal fora fora o Outside is sterile - peritoneum 1. Pepti Peptic c Ulcer Ulcer Disea Disease se a. Can cause cause GI bleedin bleedin – deeper and and deeper !! imper"oration imper"oration !! peritoneum !! peritonitis b. #tress can cause ulcer – nawawalan n blood suppl$ – shunted to other orans c. #tr #tress ess ulc ulcer er i. %elated elated to to burns burns – Curl Curlin in&s &s ulcer ulcer ii. #econdar #econdar$ $ to neuro neuroloic loical al trauma trauma-- Cushin& Cushin&s s ulcer ulcer d. 'ood ood act acts s as a bu(e bu(err e. 'ood 'oods s that that cause cause ulcer ulcerati ations ons i. )ot )ot and and spic$ ic$ ii. 'att$ iii. Ca(e Ca(ein ina ated ted i*. i*. )ih C)O+ C)O+ – releases releases pepsin pepsin !! more more astric astric secret secretion ion ". ,anaement i. ow ow C)O+ C)O+ and and low low "at"at- land land Diet Diet 1. /*oid *oid mil0 mil0 – hih hih in C)O+ C)O+ . ,edicatio ,edications ns - astri astric c irri irritant tants s i. /spirin ii. #teroids iii. +#/ID# h. Cause Cause bacter bacteria ia – ). p$lo p$lori ri i. /ntib /ntibiot iotics ics-- manae manaemen mentt i. 2$pes i. Gastric Gastric – 134 onl$5 normal normal astric astric secretio secretions ns or h$posecr h$posecretio etion n o" stomach acid- no antacids 1. )6 bloc0 bloc0er er lessen lessen amount amount o" o" acidacid- do not i*e 6. Proble Problem m mucus co*erin co*erin walls o" stomac stomach h – mas 0onti 0onti a. Goal increase increase mucus mucus prod producti uction on ii. Duodenal Duodenal – most most common common t$pe t$pe – 784 o" all all cases5 cases5 with h$per h$peracid acidit$ it$ 1. Prob Problem lem – h$pe h$perac racidi idit$ t$ – )Cl )Cl 9. ,edications i. +eutra +eutrali: li:e e astri astric c acid acid a"ter a"ter meal meals s 1. /ntacids /ntacids – does not decre decrease ase amount amount o" acid acid a. ,anes ,anesium ium-- diarr diarrhea hea b. /lu /lumin minumum- consti constipat pation ion c. Calc Calciu ium m - const constip ipat atio ion n ii. Decre Decreas ase e acid acid prod product uction ion 1. PPI- esomepr esomepra:ol a:ole e - osec- be"or be"ore e meals ;P%/
ranitidine;
a. aborti"acient – causes causes uterine contractionscontractions- prenanc$ prenanc$ cateor$ B b. most common common cause cause o" astric astric ulcer ulcer +#/ID# +#/ID# inta0einta0e- aspiri aspirin n 0. /nti ulcer ulcer drusdrus- remembe rememberr pathoph pathoph$sio $siolo$ lo$ l. /ntib /ntibiot iotics ics "or ).p$l ).p$lor orii in"ec in"ectio tions ns i. Co-amo Co-amo?ic ?icla* la* – /umen /umentin tin ii. ii. ,etr ,etron onid ida: a:ol ole e –'la –'la$ $ll iii. iii. Clarit Clarithr hrom$ om$cin cin - macr macroli olides des PPI PPI
ENDOCRINE SYSTEM MEDICATIONS - Pitui ituita tar$ r$ lan land d – mast master er lan lands ds o er$ common site o" tumors I" with tumor- most o" the time it will be a e?cessi*e disorder o o /n$ tumor in brain !! increase ICP ,anaement surer$ o )$poph$sectom$ – last option i"etime replacement replacement Problem no hormones o /nterior o Posterior O?$tocin – timulates uterine contraction /D) – asopressin ater retention or re absorption 2oo 2oo much – #I/D) #I/D) – a lot o" water water retention retention o Edema5 crac0les5 )P+ – CONGESTION o ,anaement – Diuretics5 restrict water o ith dilutional h$ponatremia – i*e h$pertonic solution – A4 +aCl Decreased – Diabetic Insipidus- DEHYDRATION o Pol$uria and pol$dipsia o Diluted urine o Polidipsia does not cause the Pol$uria Dianostic test- fuid depri*ation test – 0apa di 0a bini$an n o water> ihi 0a parin n ihi - positi*e o ,anaement Gi*e *asopressin;pitressin= 5 $pressin ;Diapid= - nasal spra$> #F and I, in9ection Gi*en "or cardiac arrest- substitute "or rst line o" dru "or C/ H Epinephrine o /nterior '#) ) Growth )ormone Growth o" bones and orans – tissues and cells ac0 G) – dwarsm o ,anaement Growth hormone until epiph$sis closes up – relati*e Do and B ra$ to chec0 er$ e?pensi*e #omatrem – #omatropin E?cessi*e E?cessi*e G) o Giantism – epiph$sis is still open
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er$ prone to osteoarthritis – too much pressure on 9oints /cromeal$ – epiph$sis is close ones will widen Chanes in ph$sical appearance is permanent e*en with medications ,anaement DOC G) antaonistantaonist- Octreotide Octreotide /cetate /cetate ;#andostatim=;#andostatim=- anti-emetic dru – can be i*en with se*ere + – underoin chemotherap$
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2#) !! 2h$roid lands !! 2A and 2J Iodine is *er$ important – li*in in mountains> oitroenics- root crops ith se*ere h$poth$roidism – m$?edema Cretinism- conenital absence o" th$roid lands /uto immune destruction o" th$roid lands – )ashimoto&s disease o #2E%OID#- all auto-immune diseases5 in addition in 2) )$poth$roidism )$poth$roidism – lahat mababa e*en peristalsis5 peristalsis5 cold intolerance intolerance o ,anaement – iodine rich "oods P%OOID- th$rolobulin e*oth$roi?ine e*oth$roi?ine – #$nthroid#$nthroid- increase the meatabolic rate o" bod$ tissues- pure "orm o" 2J ioth$ronine ioth$ronine ;C$tonnel=- pure 2A iotri? ;Euthroid= ;Euthroid= – pure 2J and 2A J1 ration Dessicated th$roid e?tracts #E- too much #+# )$perth$roidism – heat intolerance5 restless5 mala0as 0umain> pa$at5 all increased o 2h$roidectom$ 2h$roidectom$ – i" there there is a(ectation o" o" th$roid landland- tumor o" th$roid land o Goiter- h$po and h$perth$roidecom$ T3 and T4 are inversely r!!r"i!nal r!!r"i!nal "#e TSH 2h$roid land- hihl$ hihl$ *ascular – chec0 chec0 "or bleedinbleedin- chec0 bac0 o" nec0 o ,a0e it small rst- uol&s solution /nti 2h$roid medications o Inhibit th$roid hormone s$nthesis PTU $r!yl"#i!%ra&%l' reven" "#e (!r)a"i!n !( TH SE* A+ran%l!&y"!sis $ )!ni"!r (!r si+ns and in(e&"i!n 2apa:ole 2apa:ole – methima:ole methima:ole o Potassium Iodide – ##KIHuol&s solution %educe si:e and *ascularit$ o" oran pre op Inhibit 2) s$nthesis Drin0 with straw 'reLuent swallowin- tonsillectom$ 2) – "or metabolismmetabolism- #+#5 "or rowth rowth as well /drenocorticotropic )ormone – "rom adrenal corte? /C2) !! adrenal lands o !! corte? !! G,/ Glucocorticoid – Cortisol and steroids – per"ormance enhancers • • • • •
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Gluco- comes "rom lucose- ma0es lucose le*el o up #teroids pro*ides lucose- /2P – ener$ #teroids – t$pes o 'or medicine purposes – lucocorticoids- will not build up muscles – catabolic – brea0s down ener$ sources – C)O+> C)O and "ats /nabolic steroids – builds up – "or muscle o rowth Cushin&s s$ndrome – secondar$ "rom ta0in steroid "rom outside Cushin&s diseasedisease- e?cessi*e – tumor in pituitar$ land !! Mstimulation in G,/ )irsutism> deeper *oice> acne – sebaceous o lands o ith h$pernatremia5 h$ponatremia – hih K> low na diet o Edema> crac0les – conestion o /drenalectom$ ,ain hormone in adrenal corte? G- when G comes out> ,/ "ollows Catabolic in nature – brea0s down o C)O- lucose- h$perl$cemiah$perl$cemia- normal #E o" steroids o 'ats !! accumulate in areas with M #F tissues !! abdominal areas !! TRUNCAL O,ESITY shoulder !! u(alo hump o C)O+ !! amino acids !! ,uscles> most parts bod$ ones – osteoporosis #0in !! collaen !! thin s0in !! *er$ prone to stretch mar0s /ntibodies !! in"ection – immunosuppressant ,ost abundant in blood- albumindecreased – shi"tin compartmentspossible in "ace !! MOON .ACIES ,ineralocorticoid,ineralocorticoid- aldosterone – water and sodium retention /ndroens- se? hormones /ddision&s Disease #teroid 2herap$ o Prednisone> h$drocortisone %eplacement therap$ ;addison&s disease= o o /lleries> /lleries> anti-infammator$> increased ICP> autoimmune disorders> transplant> cancer SE o C%s#in+/s syndr!)e $ 0%1al! #%) )!!n (a&e "r%n&al !0esi"y •
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ede)a HPN #yerna"re)ia #irs%"is) #yer+ly&e)ia )%s&le as"in+ I))%n!s%resi!n /dminister with "ood or mil0 %eplacement- 6HA /, o" hormones – J7/,5 1HAP, o" hormones – 1-3P, Disease %? i*e in /, /ddisonian crisis – sudden stoppin o" steroid therap$ Decrease lucose> +a o !! medulla – epinephrine and norepinephrine 2umor 2umor in medullamedulla- pheochromoc$toma pheochromoc$toma – increased increased epi and nore- M#+# Pr!0le)* SEERE HYPERTENSION /nti )P+ drus and #urer$
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Dia0e"es o 2$pe 2$pe 1- adolescents5 adolescents5 auto- immune o 2$pe 2$pe 6 Insulin resistance – does not attach to the receptor o /nti Diabetic /ents Insulin 'acilitates transports o" lucose into the cells /dministered #F ,emori:e the pea0 – $ou will ha*e h$pol$cemia- i*e "oods %apid actin- ispro ;humalo= 18-13minutes5 1 hour pea05 duration A hours o o In E,E%GE+CN #I2U/2IO+# #hort actin – reular o Onset – A8 mins to 1 hour P 6-J hours5 D -7 hours Intermediate Intermediate actin +P) and ente O 6-J hours5 P 7-16 hours5 D 16-1 hours o on actin insulin o Glarine ;lantus= – no pea0 insulin- 6J hour duration Good maintenance dru5 constant concentration o" blood lucose /dministration o )ow does insulin come in concentration unitsHml o Can combine reular short actin and intermediate intermediate +P) %eular rst to aspirate- clear Clear be"ore cloud$ o Can be i*en I – reular insulin5 CG monitorin monitorin e*er$ 1 hour Insulin ad9usted considerin considerin the ph$sical and emotional stresses o" a peron o #tress- M insulin needs o E?ercise – decrease insulin needs /dminister /dminister all insulin #F %otate sides o" in9ection ;1 inch awa$= /bdomen- "astest absorption5 "ollowed b$ arms5 do not in9ect cold insulin ;lipod$stroph$= #tore in room temperature ;i" oin to use in A8 da$s= or place in re"
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i"espan o" insulin in room temp – 1 month – t$pe 1 %e"- A months – more in t$pe 6 Do not sha0e the insulin ;ubbles= Insulin pump o Continuous #F insulin in"usion in*ol*es the use o" small> e?ternall$ e?ternall$ worn de*ices that closel$ mimic the "unctionin "unctionin o" the normal pancreas o Acc s$rine o Nou Nou chane the the needle e*er$ A da$s. da$s. Deli*er$ s$stem o o asal –continuous dosin o" insulin It cannot detect h$po or h$perl$cemia o o %eLuires CG – more "reLuentl$ – A-J times a da$ .3 to 1 inch – runner – in rotatin sites In9ection in #F – lipod$stroph$5 not in the insulin itsel" Nou Nou cannot use use "or 6 -A wee0s 0apa naamit naamit na lahat n n sites in a limb !! abdomen DK/ or )++K#– blood lucose 88-788mHdl5 ) up to 1688mHdl DK/- t$pe 1 ))+K# – t$pe 6 – reular I insulin 2he more more stress> e?cited e?cited and stimulated!! stimulated!! more more lucose !! more more insulin o In"ection> sic0 o I" $ou e?ercise> 0ailanan 0umain. Oral antidiabetics %eLuire some "unctionin beta cells ower serum lucose in *ariet$ o" wa$s dependin on the dru Onl$ "or t$pe 6 o i"est$le modication !! Oral antidiabetic iuanides – decrease hepatic production o" lucose /lpha lucosidase inhibitor – bloc0s absorption o" C)O ,elitinide – stimulates release o" insulin "rom pancreas 2hia:olidinedione 2hia:olidinedione – reduces reduces cellular cellular insulin resistance resistance )$pol$cemia – h$perl$cemic aents %estlessness and Cold clamm$ s0in – rst s$mptoms #imple suars - conscious iLuid ! solild Unconscious I" with I access De?trose 384 o er$ concentrated lucose – at ris0 "or burns o #tandin order – less than 38mHdl o )ow much depends on when she will ets up o I" still unconscious- 6 pac0s – call ,D o olus – "ast push- direct I o Goal para maisin 0aaad@ o ial in the Philippines- $ellow5 U# blue +o I Glucaon #FHI, o Increase blood suar b$ stimulatin l$coenol$sis ;unconscious5 ;unconscious5 home settin5 no I= • • • •
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ANTI NEOPLASTIC AGENTS
' 2he cells are are abnormal and and mutated –carcinoenic –carcinoenic substances substances and *iruses ' Proli"eration o" abnormal cells !! can metastasi:e ' Cell c$cle G8- restin phase5 cell is not doin an$thin o Cancer cells are not susceptible susceptible to to?ic e(ects b$ chemotherap$ o G1- post mitotic phase5 preparation En:$mes necessar$ "or D+/ s$nthesis are produced C)O+- *er$ important Preparation o" all inredients o #- D+/ s$nthesis phase - methotre?ate D+/ s$nthesis ta0es place "rom D+/ separation to D+/ replication D+/- most important part o" cell o G6 – Premitotic phase %+/ and speciali:ed C)O+# are made –additional inredients o , – ,itosis – *in0a al0aloids Di*ided into J phases Prophase ,etaphase /naphase 2elophase 2elophase - Di*ide Di*ide 0a 0a n di*i di*ide> de> di di 0a pa pa 0umpl 0umpleto eto sa inr inredi edient ents s - eu0 eu0emi emia a – increas increase e leu0o leu0obla blast5 st5 *er$ *er$ prone prone to in" in"ect ection ion - Goal Goal sto stop p the the canc cancer er cell cells s 2o 2o administer aents aents in doses doses lare enouh enouh to eradicate eradicate disease disease but small enouh enouh o to minimi:e /E - Cell Cell di*i di*isio sion n one one wild@ wild@ +ormal +ormal cells cells mutate mutate - Chemot Chemother herap ap$ $ – inter" inter"er eres es with with cell cell di*i di*isi sion on - #E o one marrow depression , !! all blood cells +eutropenia- mature C o /*oid "resh fowers> "ruits and *eetables o /*oid o*ercrowded places o imit *isitors – 6 *isitors at a time o Dru to increase neutrophils +eupoen – #F and put in re"- do not sha0e the bottle – destro$ the C)O+5 same as Epoen 2hromboc$topenia 2hromboc$topenia #o"t bristled o o Electric ra:or /nemia o Gi*e Epoen- Er$thropoietin o /lopecia Co*er /ll hair o*er the bod$ +% secure patient that it is 9ust temporar$ o ,ucous membranes a(ected – stomatitis /*oid alcohol based astrinent o + /nti-emetics Dopamine antaonist – can cause EP# #erotonin antaonist – #E2%O+ – DOC o er$ e?pensi*e
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Ele*ated Uric /cid- h$peruricemia h$peruricemia $ product o" C)O+ metabolism uric acid o ,onitor "or ele*ated K also "%)!r lysis s%ndr!)e o /ll s$mptoms e?cept 2# – e?pected o 2#- /E Drus o /l0$latin dru C$clophosphamide ;c$to?an= – hemorrhaic c$stitis- increase O'I o /ntimetabolites – stops the # phase ,ethotre?ate> 3'U o /nti tumor /2 Do?orubicin - cardioto?ic leom$cin- lun brosis o ,itotic inhibitors incristine inblastine o )ormones Estroens> androens> anti-estroens ;2amo?i"en= 2umors 2umors that are hormone dependent dependent reast cancer – estroen o Gi*e anti-estroen anti-est roen – 2amo?i"en – 2a?ol /dministration o Central line-subcla*ian *ein Porta cath o Chemical burn – e?tra*asation #top the in"usion /spirate remainin dru "rom needle – do note remo*e needle rst ah ah Ice pac0 ;"or 68minutes per hour "or 6J-J7 hours= or pour +## o
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ANTI,IOTICS - ,edica ,edicatio tions ns used used to to treat treat bacter bacterial ial in"ect in"ection ions s - Cult Cultur ure e and and sens sensit iti* i*it it$ $ - Proph Proph$la $lacti ctic c therap$ therap$ ;neom ;neom$ci $cin n in colore colorecta ctall surer surer$= $= - act acter eric icid idal al – 0ill 0ill bact bacter eria ia - acter acterios iostat tatic ic – inhibi inhibitt rowt rowth h o" susce suscept ptibl ible e bacter bacteria ia - h$ with ith resis esista tan nce ce o 2a0e 2a0e antibiotics antibiotics when not needed – *iral *iral in"ections o 2a0e 2a0e / in in lon time o Did not nish duration – no s$mptom ,D% 2 - 2 on treatment Did not nish duration Fuinolones o 2a0e 2a0e lare lare doses o" / #tic0 to the lowest dose - Gene Genera rall ad* ad*er erse se react eactio ion n o /lleric – h$persensiti*it$ reactions o #uperin"ections #uperin"ections – in"ection that sets in because normal fora was one +'- protects "rom some 0inds o" in"ection – "unal in"ections road spectrum /- 0ills both ram positi*e and neati*e microbes +arrow spectrum
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Oran to?icit$ )epatoto?ic and nephroto?ic
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Penicillin – GI s$mptoms5 h$persenti*it$ reaction #a"est5 most popular and most abused ,an$ microbes – resistance Diarrhea> abdominal pain Pen G – DOC "or s$philis-2reponema pallidum eta- actam- chemical structure o" PC+ Cephalosporin #ame chemical structure as PC+5 beta lactam ,ore prone to superin"ection Possible "or cross resistance5 cross aller$ – PC+ CE' or KE' road spectrum )aban tumataas> mas broad spectrum – le*els o" enerations 2etrac$lcine 2etrac$lcine – $ellow $ellow teeth5 $ellow $ellow sunQ sunQ Nellowish Nellowish discoloration discoloration o" teeth ; do not use "or last hal" o" prenanc$ prenanc$ till 7 $ears o" ae= Photosensiti*e Do not i*e until permanent teeth has erupted Do not i*e with children – stron aRnit$ with calcium /minol$coside +ephroto?ic Ototo?ic ;7th C+= /coustic ner*e )earin and balance 2innitus 2innitus and *ertio Gentam$cin #treptom$cin 2obram$cin 2obram$cin +eom$cin ,NCI+ Fuinolones C$stalluria – cr$stalli:ation in the urine – bladder – stones MO'I Photosensiti*it$ 'OB/CI+ 'or U2I and %2I Ciprofo?acin- Ciproba$ /ccordin /ccordin to DO) – ,D% 2 – alternati*e to %IPE#- Luinolones ,acrolides GI irritant 2a0e 2a0e with "ood Er$throm$cin- ta0e "or 1J da$s /:ithrom$cin /:ithrom$cin – a:ithroma? – i*e OD dru "or A da$s – "or P+, – C/P ancom$cin %ed man s$ndrome Causes *asodilation %edness )$potension when in"used too "ast %ed nec0 s$ndrome – sin start "rom nec0
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%eason in"usion o" too "ast DOC ,%#/ in"ection Common nosocomial in"ection DOC Clostridium diRcile – diarrhea – most common nosocomial in"ection #ul"onamides Cr$talluria Photosensiti*it$ #te*en Sohnson #$ndrome – s0in condition – as i" the$ ha*e second deree burns Oldest drus – all with sul"a Cotrimo?a:ole 'or U2I and %2I DOC "or s0in in"ections – "or burn in9ur$ #il*er #ul"adie:ine #ul"adie:ine #il*er +itrate •
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ANTITU,ERCULAR DRUGS - #ide E(ects o % hepatoto?ic discoloration o" all secretions o I+) Peripheral neuritis ;bloc0s *itamin = )epatoto?icit$ er$ prone – onl$ A months o P
ANTI.UNGAL MEDICATION - /mphoter /mphotericin icin - DOC DOC "or s$stemic s$stemic "unal "unal in"ec in"ection tionss- blood blood in"ectio in"ections ns #ha0e and ba0e – chills and "e*er – normal #E o - +$statin o /dministered orall$ or topicall$ to treat candidal in"ection aina or mouth5 s0in aina – chees$ li0e drainae "rom *aina- $east in"ection ainal tablet or suppositor$ o #wish and swallow or swish and spit o #uspensions> #uspensions> powder> cream> ointment> *ainal tablets Oral – oral thrush – white patches – suspension5 attachment #wallow- astric 'unal in"ections common in moist areas – powder> cream or ointments o - Imida:ole o Ketocona:ole ;+i:oral= o ,icona:ole o Clotrima:ole o 'lucona:ole ;Difucan= o DOC "or rinworm
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2inea corporiscorporis- bod$ Capitis – head Pedis – "eet
ANTIIRAL MEDICATIONS - /ll ne nephroto?ic - /c$clo*ir – #o #o*ira? HYPERURICEMIA - Reas!ns* o Purine rich "oods o De"ecti*e uric acid ! accumulation o" uric acid ! Kidne$ stones Soints 2ophi 2ophi – uric acid deposition deposition Gout$ arthritis – infammation o DOC too much pain – Colchicine o Uric acid s$nthesis inhibitor – /llopurinol – <$loprim o Uricosurics – Probenecid ;enemid= – taatanal n U/ o /E +ephroto?ic- increase O'I
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ANALGESICS - +ar +arcoti cotic c and and non non narc narcot otic ic ana anal les esic ics s - Opio Opiod d – pur pure "or "orm m ,orp ,orphi hine ne o #$nthetic- Demerol o Codeine o +arcotic /lter perception o" and response to pain Decrease #> alertness> couh and peristalsis Constrict pupils /ddicti*e o ,orphine sul"ate E(ecti*e "or acute pain due to /,I> cancer> post op pain ,onitor "or %% /ntidote +alo?one ;narcan= Do not i*e in cholec$stitis – can cause spasm o" the sphincter o" Oddi Instead i*e Demerol- meperidine5 i" anti spasmodic is not a*ailable "rom choices- cholec$stitis Give in an&rea"i"is 555 o ,eperidine – Demerol #horter actin #$nthetic opiate aonist Post op pain5 prenanc$ +euroto?ic – con"usion in elderl$ Elederl$ – neuroto?icit$ can result DOC in and cholec$stitis - +on narcot narcoticic- stops stops prost prostal aland andin in s$nt s$nthes hesis is o #alic$lates- most e(ect o" all %educes %educes pain> "e*er> anti-infammator$> anti-platelet Causes bleedin> GI irritation> ototo?ic ;7 th C+= Don&t i*e to children $ouner than 16 $ears old with fu li0e or *iral s$mptoms
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%e$e&s #$ndrome – *omitin and lethar$ and coma
+#/ID# +o anti platelet Gastric irritants5 hepato?ic and nephroto?ic ,e"enamic acid> ibupro"en and 0etorolac> toradol COB II inhibitors COBI – Celeco?ib – less astric irritation /cetaminophen /cetaminophen or paracetamol /cetaminophen /cetaminophen – no anti infammator$ )epatoto?ic ,a? dose J per da$ /ntidote /cet$lc$steine – ,ucom$st +eo aspilet or +eo 0idilet – paracetamol east e(ect than others
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CNS ' ' ' ' ' ' '
STIMULANTS Uppers ,etamphetamine- shabu #+# and C+# - M#> h$perl$cemia /mphetamines – adderall Ca(eine- *i*arin De?troamphetamine- De?edrine ,eth$lphenidate ,eth$lphenidate – %italin – /D)D- more "ocus and concentrated Parado?ical – opposite5 rela?ation o ' Indications +arcoleps$ o o /D)D /ppetite control o o O0esi"y – direct e(ect on h$pothalamus- depress appetite center- e(ects are temporar$ Reversal !( resira"!ry dis"ress o - E(ects o Insomnia> restlessness> irritabilit$> )P+> tach$cardia> dru dependence and tolerance o Ceilin e(ect – dru tolerance - +% o /nore?iant e(ect are temporar$ 2o 2o a*oid insomnia> insomnia> ta0e hours be"ore be"ore bed time o o Do not abruptl$ withdraw the dru – withdrawal s$mptoms /ssess P and pulse durin treatment o o /nti )P+ and anti diabetic doses ma$ need to be ad9usted
CNS -
DEPRESSANTS #edati #edati*es *es-- rela rela?5 ?5 most mostl$ l$ use used d duri durin n da$ time time )$pnosis – sleep General #E o %esidual drowsiness ;hano*er= o Dru dependence o Dru tolerance o ithdrawal s$mptoms - /lcohol - #-) #-) ! !! ! ""or or sei: sei:ur ure5 e5 ant antii con con*u *uls lsan ants ts o arbiturates
Decrease impulse transmission to the cerebral corte? Used "or epileps$ and sei:ures> insomnia and sedation Cateories Ultra short o 2hiam$lal> thiopental thiopental +a – anesthesia anesthesia #hort Pentobarbital> secobarbital o on - sei:ures o Phenobarbital – uminal – "or epileps$ en:odia:epines ,ost "reLuentl$ prescribed sedati*e- h$pnotics5 an?iol$tics Used also as ad9unct "or sei:ure acti*it$ %elie" o" delirium tremens – alcohol withdrawal Dia:epam – *alium ora:epam – ati*an ,ida:olam – Dormicum Grand mal sei:uressei:ures- Phenobarbital5 Phenobarbital5 ben:odia:epines ben:odia:epines Unconscious /bsence sei:uresei:ure- can be 188? per da$5 common in J-16 $ears oldold- DOC ben:odia:epines /wa0e and conscious> unaware5 tulala #tatus epilepticus – one sei:ure a"ter the other- suunod sunod5 a"ter stoppin o" anti con*ulsants5 DOC DI/ panic disorders Epileps$ /nesthesia
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ANTI CONULSANTS - arb arbit itur urat ates es-- Ph Phen enob obar arbi bita tall - Phen hen$to $toin –Dil Dilant antin o #E drowsiness> sedati*e> di::iness> h$potension> leucopenia> GI+GI/ )NPE%P/#I/ ;Dilantin=5 teratoenic o /ssess sei:ure acti*it$ /ssess oral mucous membranes o o I- mi? with +#l not with de?trose- precipitate o ,onitor phen$toin le*el – 18-68 microramsHml o Urine ma$ turn pin0 o +C "or G) Oral care ,assae the ums
