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SYSTEM DRUGS
Nervous systems' major division
SYMPATHETIC PARASYMPATHETIC
(FIGHT OR FLIGHT) (REST AND DIGEST)
Classes of Medications for treating CNS disorders
1. Analgesics
a. Opiods/Narcotics
b. NSAIDS (nonstreroidal anti-inflammatory drugs) and
paracetamol
2. Antiseizure/antiepileptic agents
3. Medications for neurodegenerative agents
4. Muscle relaxants
5. Local anesthetics
ANALGESICS
Analgesics and Pain Management
Analgesics is a broad term used to describe medications that provide
pain relief.
Primary classes: Narcotics
Non-narcotics (P-aminophenol der., NSAIDS)
I. NON-NARCOTICS
A. P-aminophenol derivative
1. Phenacetin- prodrug----> APAP (Acetaminophen)
-withdrawn due to nephrotoxicity and methemoglobinemia
2. Acetaminophen/Paracetamol- uses: Analgesic & Antipyretic; safe in
pregnant, lactating woman & among children.
T/E: Hepatotoxicity (hepatic necrosis), Nausea & vomiting, abdominal pain,
and jaundice
B. NSAIDS- weak organic acids except Nabumetone
MOA: block COX ---> ↓PG synthesis
1. COX1- For PGs responsible for maintenance functions
2. COX2- Inducible enzymes; PGs for pain & inflammation
Classifications:
I. Non-selective
a. Aspirin- uses: Analgesic, Anti-inflammatory property,
Antipyretic, antiplatelet/antiaggregant
T/E: GI effects, Hypersensitivity reactions, effects in serum uric
acid level, CNS effects, Reye's syndrome
b. Indole derivative
ex: Indomethacin- inhibits COX1 & COX2; inhibits GI effects
use: mngt of Ductus Arteriosus
mngt of Barter's Syndrome
tx of pain in acute gout
II. NARCOTICS
Narcosis- stupor and insensibility
MOA: stimulate the release or mimic the action of endogenous
opiod peptides (enkephalins, dymorphins, endorphins,
endomorphins
Receptors: Mu, kappa, delta
Uses: Analgesics- Mild: Tramadol
Moderate: Codeine
Severe: Morphine
Management of Acute Pulmonary Edema
c. Synthetic (Opiods)
i. Methadone- same efficacy with morphine
-good oral BA
-long DOA (less rapid of dev't of tolerance)
use: to wean-off of addicted to Morphine and Heroin
ii. Meperidine/Pethidine (Demerol)
-no cardiac & biliary effects
-used for acute pain only (NMT 5 days)
iii. Levorphanol
-5-7x more potent than morphine
iv. Tramadol
- weak der. of codeine
v. Fentanyl & related drugs (alfentanyl, sulfentanyl)
- 100x more potent than morphine
Based on Pharmacodynamics:
Pentazocine
Hallucination Alogia
Delusions Anhedonia
2. Atypical/2nd Generation
MOA: blocks 5HT >>> D2
e.g Clozapine, Olanzapine, Quetiapine,
ANTIDEPRESSANTS
Signs & Symptoms:
• anhedonia
• difficulty sleeping/ oversleeping
• lack of appetite
• worthlessness
• suicidal ideation
• asociality
2. Carbamazepine
uses: GTC & partial seizure, bipolar disorder, trigeminal neuralgia
SE: Diplopia, SJS, Hyponatremia
3. Valproic acid
uses: DOC for BPD, GTC, absence (complicated)
SE: daytime sedation, weight gain, alopecia, teratogenic
4. Phenobarbital
uses: GTC, status epi, partial seizure, primary anti seizure for
children, infants, and pregnant women
5. Ethosuximide
use: simple absence
SE: behavioral changes
8. Lamotrigine
uses: DOC for partial seizure, BPD, myoclonic seizure
9. Levetiracetam
uses: GTC, partial
10. Topiramate
uses: migraine, GTC, partial seizure
Drugs for Parkinsons Disease
Parkinsons- neurodegenerative disease caused by
degeneration of dopaminergic neurons
1. Levodopa-carbidopa
use: 1st line for parkinsons dse
SE: GI upset, Behavioral changes
STAGES OF ANESTHESIA
1. Analgesia- decrease awareness to pain
2. Disinhibition- delirious, muscle excitation, amnesia, irregular
respiration, incontinence, vomiting
3. Surgical anesthesia- unconscious, no pain reflexes, no
muscle reflexes and contraction, stable vs
4. Medullary depression- severe CV and respiratory dep
ROUTES OF ADMINISTRATION
1. INHALATIONAL ANESTHETICS
Mimimum Alveolar Concentration (MAC)
-dose required to eliminate painful response in 50% of Px
Most Potent: methoxyflurane
Least Potent: Nitrous Oxide
a. Nitrous Oxide
b. Desflurane
c. Sevoflurane
d. Isoflurane
e. Halothane
f. Enflurane
2. INTRAVENOUS ANESTHETIC
a. Thiopental
b. Midazolam
c. Ketamine
d. Etomidate
e. Fentanyl, Morphine
f. Propofol
II. LOCAL ANESTHETICS
a. Esters
b. Amide