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Pharmacology > Drugs Affecting The CNS > Flashcards

Drugs Affecting The CNS Flashcards

1
Q

What are the drugs that effect the CNS? And how it affects it?

A

Sedative drugs, these drugs exert their effects by interacting with neurotransmissions, by effecting neurotransmitter release, metabolism, uptake or by acting at primary or modifying receptors, or transport proteins.
To sum up,
Release
Metabolism
Uptake
Action at receptor site
Transport protein

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2
Q

What are the clinical effect of CNS drug?

A

Depends on the localization of specific neurotransmitters in specific brain areas.

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3
Q

What is the main side effect of CNS drugs?

A

CNS is complex, main cause of the side effect of CNS drug is their interaction in diffuse brain areas.

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4
Q

What are clinical & side effects of CNS drugs?

A

Function
Mood
Perception of pain
Anxiety
Sleep
Memory

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5
Q

What is anxiolytics?

A

They are minor tranquilizers. These drugs are used to treat anxiety disorders and insomnia. Most common class of anxiolytics is benzodiazepines.

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6
Q

Which is the most common class of anxiolytics?

A

Most common class of anxiolytics is benzodiazepines.

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7
Q

What is the indication of anxiolytics (benzodiazepines)?

A

Outpatient and inpatient.
Outpatient includes daily or sporadic anxiety.
Inpatient includes pre-procedure for anxiety, procedural sedation and amnesia, terminate seizures or increase threshold.

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8
Q

Drug name for anxiolytics (benzodiazepines)

A

Outpatient-
alprazolam
Diazepam
Lorazepam
Inpatient
Midazolam- IV- GIVEN FOR SEDATION, remember we are talking about CNS sedative drugs.

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9
Q

Specific antagonist for benzodiazepines?

A

Flumazenil- to reverse overdose.

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10
Q

What is the MOA for Benzodiazepines?

A
  1. Depress the nerve synapse in RAS
  2. Bind to receptors within GABA complex on the neuron.
    3.increase chloride channel permeability leading to hyperpolarization(lack of repolarization
  3. Results in decrease or inhibits neurotransmission or decrease neuronal function.
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11
Q

What is the side effect of benzodiazepines?

A

Decrease consciousness and psychosis

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12
Q

Which drug is widely replaced with benzodiazepines?

A

Barbiturates.
It depress the neuron activity, but has high risk of addiction and abuse.

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13
Q

What are analgesics?

A

Drugs that provide pain relief. It can be subdivided into narcotics and non-narcotics.

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14
Q

How is pain experience based on?

A
  1. Pain sensation- input from the CNS pain receptors
  2. Suffering- Negative emotional response to pain.
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15
Q

What are the types of pain?

A

1.Nociceptive pain-tissue damage
Pain arising from the stimulation of nerve cells due to thermal(hot pan), chemical(spicy chicken) or mechanical stimulation(dropping of pan on your toe).

  1. Neuropathic pain- nerve pain
    Damage or disease affecting any part of nervous system
    Peripheral neuropathic pain is the burning, tingling or pins and needles(neuropathy)
  2. Psychogenic- pain caused, increased or prolonged by mental, emotional or behavioral factors
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16
Q

Name the 3 categories under analgesics/anti-pyretics

A

NSAIDS, Opioids, Local anesthetics.

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17
Q

What is the MOA for NSAIDS(Aspirin, parasol, ibrufen)?

A
  1. Inhibits inflammatory mediators(prostaglandins, cyclooxygenase) at peripheral pain stimulus (reduces pain and inflammation).
  2. Inhibit production of pyrogens to prevent adjustment of body temperature in the hypothalamus (reduced fever)
  3. Inhibit breakdown of arachidonic acid.
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18
Q

What is the indication for Aspirin/ acetylsalicylic acid?

A

Anti-inflammatory- to reduce inflammation
Anti-pyretic- to reduce pain
Analgesic-
Anti-platelet (baby dose)

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19
Q

Side effect of Aspirin?

A

Caution with asthmatics- samters syndrome
Caution with ulcers/GI bleed- most common
Caution with children- Reye’s syndrome
Overdose= metabolic acidosis due to kussmaul breathing

20
Q

What is indication for acetaminophen/parasol/tylenol?

A

Anti-pyretic(for fever)
Analgesic(for pain)

21
Q

What is the category of acetaminophen?

A

Aniline derivatives

22
Q

What are the side effects of acetaminophen?

A

Minimal to no anti inflammatory or anti platelet action

23
Q

What does drug overdose lead to when taking acetaminophen?

A

It means panadol, it leads to hepatic toxicity.

24
Q

What is indication for ibrufen and naproxen?

A

Anti-inflammatory
Analgesic
Anti-pyretic

25
Q

What are the side effects of ibrufen and naproxen?

A

Gastric irritation
Caution with asthmatics
Less tolerated than paracetamol and has higher drug interaction

26
Q

Ibrufen and naproxen is what derivative?

A

Propionic acid derivative

27
Q

What are Opiods/analgesics?

A

They are narcotics derived from opium.

28
Q

Name endogenous and exogenous opiods

A

Endogenous- endorphins and enkephalins
Exogenous(narcotics)- opium

29
Q

Indication for opioids

A

For Moderate to severe pain
Used along balanced anesthetics(paired with a muscle relaxant and induction agent)

30
Q

ROA for opiods

A

IV (Peripheral, PCA and epidural), topical, PO, Inhalation

31
Q

MOA for opiods

A
  1. Act on the opioids receptors in the brain, spinal cord, some other areas to close calcium channels
  2. Creates hyperpolarization
  3. Decreases neuronal cell excitability
  4. Reduces transmission of impulses related to pain but cause CNS depressing effects.
32
Q

what is morphine/analgesics?

A

Main therapeutic use is analgesics, sedation(balanced anesthesia or combination), vasodilator (MI, CHF)

33
Q

What are the main side effects of Morphine?

A

Histamine release- asthma
Hypotension
Emesis(vomiting)
Constipation
Respiratory depression

34
Q

What is fentanyl?

A

Main therapeutic use is
• fentanyl is synthetic derivative of Morphine so similar
uses
• 80-100 times the potency of morphine(strong)
• Shorter half life than morphine (huge
benefit)
• Chest rigidity may occur affecting
ventilation prior to intubation

35
Q

Antagonist for narcotics

A

Naloxone, is a narcotic antagonist that competes with narcotics at opioid receptors, has high affinity but no efficacy.
It’s therapeutic use is to reverse the unintended respiratory depression

36
Q

ROA for Naloxone

A

IV, TOPICAL through nares for immediate response, IM for sustained.

37
Q

What is indication of Local anesthetics?

A

• localized pain control (stiches, cyst removal, dental procedures)
• Epinephrine often added for vasoconstriction, slowing absorption
• terminating cardiac conduction abnormalities
• suppress irritant tracheal cough response (bronchoscopy and
others)

38
Q

MOA for local anes

A

Interrupt nerve signals (pain) from damaged area by blocking Na+
channels along nerve cells

39
Q

Drug name for local anes

A

Lidocaine, also given in inhalation/nebulization form to suppress gag in bronchoscopy

40
Q

Indication for epidural anes

A

Birth, awake surgery or post surgical pain control.
It comprises of local anes + opioid+ combo anes= injected or infused into the epidural space.

41
Q

Side effect of epidural

A

Reduced or eliminated feeling
Spinal damage

42
Q

What are IV anesthetics(white milk)

A

They are used to induce anesthesia or absence of perception,
they are dose dependent, they are combined with analgesics and muscle relaxant in critical care. They can be used short term- bolus when intubation, procedural or conscious sedation, or long term- infusion to maintain anesthesia when on MV for instance.

43
Q

Benzodiazepines & Barbiturates “ can” be considered induction agents, but they are not commonly used for IV anesthetics or as induction agents. True or false

A

True, Midazolam are considered induction agents but not commonly used.

44
Q

Why is IV anesthetics given?

A

They are inducing anesthesia, when during procedure. Half life is short. Sedation is minimal(short half life), moderate, and deep (quick).

45
Q

Key comparison between etomodate, propofol and ketamine.

A

All of them are for sedations:

Etomodate: also given for hypotension but not better than ketamine, however it is better than propofol. It reduces seizure threshold(side effect)

Propofol: stops seizure, cerebral protective. vasodilation, reduces C.O and reduces BP, pain at the site of injection are all side effects.
Ideal situation: status epilepticus.

Ketamine: only sedative which is sympathomimetics. Therefore, increases heart rate, BP and bronchodilation. Ketamine is given for severe hypotension patients to put them to sleep. Increases ICP. Causes hallucinations. Ideal situation: status asthmatics, anaphylaxis.
Side effects: dissociative state, increase ICP, so shud be not be given to Hypertensive patient.

Pharmacology (4 decks)

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