Drugs affecting Nervous System

.
Anesthetics Drugs

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 Objectives
By the completion of this section the learners will be
able to:
1. Define the term anesthesia and anesthetic agents.
2. Differentiate between different types of anesthesia.
3. Identify the stages of general anesthesia.
4. Describe Characteristics of general and local
anesthetic agents.
5. Identify most commonly used anesthetic agents.

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 .

6. Discuss factors considered when choosing anesthetic

agents.
7. Compare general and local anesthesia in terms of
administration, client's safety and nursing care.
8. Discuss the rationale for using adjunctive drugs before and
during surgical procedures.
9. Describe the nursing role in related to anesthetics and
adjunctive drugs.
10. Discuss the action, indication and side effects of neuro-
muscular blocking agent .
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 Anesthesia
Anesthesia is the loss of sensation with or with out
loss of consciousness without loss of vital functions
artificially produced by the administration of one or
more agents that block the passage of pain
impulses along nerve pathways to the brain.

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 Types of Anesthesia

1) Local anesthetic.
– is the provision of a pain-free state in a specific area (or region). local anesthesia is where a
small area of the body is numbed and you remain fully conscious .
Structurally local anesthetics are of two types .
• A) Ester
• Chloroprocaine, procaine, and tetracaine . .
• B) Amide
lidocaine, mepivacaine, prilocaine, bupivacaine, etidocaine

2) General anesthetic.
– is the provision of a pain-free state for the entire body. General anesthetic are given parentally
or by inhalation .
– A) Inhalational (nitrous oxide NO , Halothane, Isoflurane, Sevoflurane, chloroform , Ethyl
chloride)
– B) Intravenous (Benzodiazepines) midazolam, Propofol , thiopental, ketamine, and (opioid)
Fentenals.

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 LOCAL ANESTHESIA
• Topical Anesthesia
• Involves the application of the anesthetic to the surface
of the skin, open area, or mucous membrane.
• Local Infiltration Anesthesia
• Is the injection of a local anesthetic drug into tissues.
This type of anesthesia may be used for dental
procedures, the suturing of small wounds, or making an
incision into a small area, such as that required for
removing a superficial piece of tissue for biopsy.
• Regional Anesthesia
• Is the injection of a local anesthetic around nerves so
that the area supplied by these nerves will not send
pain signals to the brain.
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Preparing the Patient for Local Anesthesia

Preparing the patient for local anesthesia may or may

not be similar but according to the case a nurse may,

• explain to the patient how the anesthetic will be administered.

• take a patient’s allergy history.
• when applicable, prepare the area to be anesthetized, which may
involve cleaning the area with an antiseptic or shaving the area.
• fasting
• administer an intravenous sedative such as the antianxiety drug

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 PRE ANESTHETIC DRUGS:

The general purpose of the pre anesthetic drug

is to prepare the patient for anesthesia.

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GENERAL ANESTHESIA
The neurophysiologic state produced by
general anesthetics is characterized by five
primary effects: unconsciousness, amnesia,
analgesia, inhibition of autonomic reflexes, and
skeletal muscle relaxation.

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 Choice
It depends on many factors including,

• The general physical condition of the patient

• The area, organ, or system being operated on
• The anticipated length of the surgical
procedure.

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 Administration
• Most commonly by IV or inhalation.
• Gas anesthetics are combined with oxygen
and administered by inhalation.

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 Skeletal Muscle Relaxants
• These drugs are
administered to
produce relaxation
of the skeletal
muscles during
certain types of
surgeries, such as
those involving the
chest or abdomen.
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 Stages of General Anesthesia
• STAGE I : Loss of consciousness
– It begins with the administration of an anesthetic drug and lasts until
consciousness is lost.
• STAGE II Delirium / Excitement
– Stage II is the stage of delirium( is a mental state in which pt is confused, disoriented and do not able to
think or remember clearly) and excitement ( uncontrolled movements, loss of eyelash reflex, hypertension, and

tachycardia etc.).In this stage voluntary muscles become more active .

• STAGE III Surgical stage

– Stage III is the stage of surgical analgesia in which all vitals become
stable e.g. R.R,B.P,H.R and surgery can be performed .
• STAGE IV medullary Paralysis consciousness
– Stage IV is the stage of respiratory paralysis and Cardiac arrest and is a
rare and dangerous stage of anesthesia .

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 Nursing Responsibilities During the
Administration of General Anesthesia
• Preanesthesia
– Performing the required tasks and procedures as
prescribed by the physician and hospital policy the day or
evening before or the morning of surgery and recording
these tasks on the patient’s chart.
– Checking the chart for any recent, abnormal laboratory
tests.
– Placing a list of known or suspected drug allergies.
– Administering the preanesthetic (preoperative)drug.
– Instructing the patient to remain in bed and placing the
side rails up once the preanesthetic drug has been given.
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• Postanesthesia:
– Checking the airway for patency, assessing the
respiratory status, and giving oxygen as needed.
– Positioning the patient to prevent aspiration of
vomitus and secretions.
– Checking blood pressure, pulse, intravenous lines,
catheters, drainage tubes, surgical dressings, and
casts.
– Checking the patient every 5 to 15 minutes for
emergence from anesthesia.
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 Factors that may Alter Anesthetic
Response
• SOLUBILITY
• ANESTHETIC CONCENTRATION IN THE
INSPIRED AIR
• PULMONARY VENTILATION
• PULMONARY BLOOD FLOW
• ARTERIOVENOUS CONCENTRATION GRADIENT

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 Drugs Used for General Anesthesia
• Methohexital and Thiopental
– These drugs have a rapid onset and a short duration of action. They
depress the central nervous system (CNS) to produce hypnosis and
anesthesia but do not produce analgesia. Recovery after a small dose
is rapid.
• Etomidate
– Etomidate also may be used to supplement other anesthetics, such as
nitrous oxide, for short surgical procedures. It is a hypnotic without
analgesic activity.
• Propofol
– used for induction and maintenance of anesthesia. It also may be used
for sedation during diagnostic procedures and procedures that use a
local anesthetic

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• Midazolam
– a short-acting benzodiazepine CNS depressant, is used as a
preanesthetic drug to relieve anxiety; for induction of anesthesia; for
conscious sedation before minor procedures.
• Sevoflurane
– an inhalational analgesic. It is used for induction and maintenance of
general anesthesia in adult and pediatric patients.
• Cyclopropane
– An anesthetic gas, cyclopropane has a rapid onset of action and may
be used for induction and maintenance of anesthesia. Skeletal muscle
relaxation is produced with full anesthetic doses.
• Ethylene
– anesthetic gas with a rapid onset of action and a rapid recovery from
its anesthetic effects. It provides adequate analgesia but has poor
muscle-relaxant properties.
• Remifentanil Hydrochloride cautiously in patients with a history of
hypersensitivity to fentanyl.
• Halothane (volatile liquid) Raheem khan 25
Anti-Convulsants or
Anti- Epileptic drugs

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 Objectives
• By the completion of this section the learners will
be able to:
1. Discuss the pharmacokinetics, side effects and
adverse reactions, therapeutic plasma phenytoin
level.
2. Identify the contraindications and drug
interactions.
3. Explain the nursing interventions, including client
teaching related to the use of anti-convulsants.
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Epilepsy:
Epilepsy is a disorder of the brain characterized by repeated seizures. A
seizure is usually defined as a sudden alteration of behavior due to a temporary
change in the electrical functioning of the brain.
Epilepsy is a chronic non communicable disease of the brain that affects people of all
ages.
Around 50 million people worldwide have epilepsy, making it one of the most common
neurological diseases globally.
Seizure episodes are a result of excessive electrical discharges in a group of brain cells.
Different parts of the brain can be the site of such discharges.

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 What do we mean by seizures?

A seizure may be described as an

abnormal disturbance in the electrical
activity in one or more areas of the brain.

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 Types of seizures
1.Partial or focal seizures arise from a localized area in the brain
and cause specific symptoms.
.Simple partial seizures
.Complex partial seizures
2.Generalized seizures
• Absence Seizures also known as (petit mal) seizures.
• Clonic seizures.
• Myoclonic seizures.
• Tonic-clonic seizures.
• Atonic seizures.

https://youtu.be/RxgZJA625QQ?si=XMUm8nDRS5zfdfK6
https://youtu.be/gUzTE_sG2eQ?si=DpuTnSlWFwfMl_Fb

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Causes:
Epilepsy is not contagious. Although many underlying disease
mechanisms can lead to epilepsy. The causes of epilepsy are divided into
the following categories: structural, genetical, infectious, metabolic,
immune and unknown.
Examples include: brain damage from prenatal or perinatal causes (e.g. a
loss of oxygen or trauma during birth, low birth weight);
congenital abnormalities or genetic conditions with associated brain
malformations;
A severe head injury and brain tumor.
A stroke that restricts the amount of oxygen to the brain;
An infection of the brain such as meningitis, encephalitis or
neurocysticercosis,
certain genetic syndromes;

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 There are five types of drugs used as anticonvulsants:

1. Barbiturates (Phenobarbital).
2. Benzodiazepines (Valium, Ativan, Xanax).
3. Hydantoins (phenytoin).
4. Oxazolidinedione (to treat absence (petit mal)
seizures.
5. Succinimides ( ethosuximide).

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 ACTIONS

Generally, anticonvulsants reduce the excitability of the

neurons (nerve cells) of the brain. When neuron
excitability is decreased, seizures are theoretically
reduced in intensity and frequency of occurrence or, in
some instances, are virtually eliminated.

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 Use in Pregnancy
increased incidence of birth defects in children
The use of anticonvulsants generally is not
discontinued in
pregnant women with a history of major seizures
because of
the danger of precipitating status epilepticus.
However, when
seizure activity poses no serious threat to the
pregnant
woman, the primary health care provider will
consider discontinuing use of the drug during
pregnancy.

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 ADVERSE REACTIONS:
• Barbiturates (e.g. phenobarbital )
• Sedation in varying degrees..
• may also cause nausea, vomiting, constipation, bradycardia,
hypoventilation, skin rash, headache, fever, and diarrhea.
• Agitation, rather than sedation, may occur in some patients.

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Benzodiazepines (e.g. clonazepam, diazepam)
Sedation in varying degrees.
anorexia, constipation, or diarrhea.
Some adverse reactions are dose dependent, whereas others
may Diminish in intensity or cause few problems after several
weeks of therapy.

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• Hydantoins (e.g. Phenytoin)
• Nystagmus (uncontrollable eye movements.)
• ataxia
• skin rashes, nausea, vomiting, gingival hyperplasia ,
hematologic changes and hepatotoxicity
• Some of these adverse reactions diminish with
continuous use of the hydantoins.

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Oxazolidinediones (e.g. Trimethadione)
Hematologic changes, such as pancytopenia.
Also reported are various types of skin rashes, diplopia , vomiting,
changes in blood pressure,
CNS depression, photosensitivity, and fatal nephrosis .
Trimethadione , used in the treatment of absence seizures,. They are
less effective and have the potentially serious side effects of aplastic
anemia, visual impairment, and the nephrotic syndrome.

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• Succinimides (e.g. ethosuximide , methsuximide and
.

phensuximide)
• Succinimide anticonvulsants are mostly used to treat absence seizures.
• Mental confusion and other personality changes.
• pruritus, urticaria, urinary frequency, weight loss, and hematologic
changes may also be seen.

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 NURSINGPROCESS
• ASSESSMENT
– Pre administration Assessment
• A thorough patient history is necessary to identify the
type of seizure disorder.
– A description of the seizures (the motor or psychic activity
occurring during the seizure)
– The frequency of the seizures (approximate number per day)
– The average length of a seizure
– A description of an aura (a subjective sensation preceding a
seizure)
– degree of impairment of consciousness
– A description of what, if anything, appears to bring on the
seizure.
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Anti Parkinson’s Drugs

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 Objectives
At the end of this topic students will be able
to,
• Explain parkinsonism.
• Describe the actions of anti cholinergic and dopaminergic drugs
in treatment of parkinsonism.
• Differentiate between the types of commonly used anti
parkinson’s drugs.
• Describe the side effects of anti parkinson’s drugs.
• Discuss nursing interventions including clients teaching, of drugs
used in the treatment of parkinson’s disease.
• Calculate the drug dosage accurately for oral and parenteral anti
parkinson’s drugs.
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 Parkinson’s Disease
Parkinson’s disease, also called paralysis agitans, is a degenerative disorder of the
central nervous system (CNS). Parkinson’s disease is a brain disorder that causes
unintended or uncontrollable movements, such as shaking, stiffness, and difficulty
with balance and coordination . The disease is thought to be caused by a deficiency
of dopamine and an excess of acetylcholine within the CNS.

Parkinson’s disease affects the part of the brain that controls muscle movement,
causing such symptoms as
Trembling,
Rigidity,
Difficulty walking, and
Problems in balance.

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 Parkinson’s disease, also called paralysis agitans, is a
degenerative disorder of the central nervous system (CNS).
The disease is thought to be caused by a deficiency of
dopamine and an excess of acetylcholine within the CNS.

• Parkinson’s disease affects the part of the brain that controls

muscle movement, causing such symptoms as
• Trembling,
• Rigidity,
• Difficulty walking, and
• Problems in balance.

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Symptoms of Parkinson’s disease
Parkinson’s has four main symptoms:
• Involuntary shaking of particular parts of the body (tremor).

• Slow movement.

• Stiff and inflexible muscles.

 Tremor in hands, arms, legs, jaw, or head.

 Muscle stiffness, where muscle remains contracted for a long time.
 Slowness of movement.
 Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
 Depression and other emotional changes.
 Difficulty swallowing, chewing, and speaking.
 Urinary problems or constipation.
 Skin problems.

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Diagnosis of Parkinson’s disease
There are currently no blood or laboratory tests to diagnose non-genetic
cases of Parkinson’s. Physician usually diagnose the disease by taking a
person’s medical history and performing a neurological examination.
If symptoms improve after starting to take medication, it’s another indicator
that the person has Parkinson’s.

Deep brain stimulation

For people with Parkinson’s disease who do not
respond well to medications, the doctor may recommend deep brain
stimulation. During a surgical procedure, a doctor implants electrodes into
part of the brain and connects them to a small electrical device implanted in
the chest. The device and electrodes painlessly stimulate specific areas in
the brain that control movement in a way that may help stop many of the
movement-related symptoms of Parkinson’s, such as tremor, slowness of
movement, and rigidity.

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 DOPAMINERGIC DRUGS
• Dopaminergic drugs are drugs that affect the
dopamine content of the brain.
These drugs include:
• Levodopa.
• Carbidopa.
• Amantadine.
• Pergolide mesylate .

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 ACTIONS
• Dopamine, when given orally, does not cross the
blood–brain barrier and therefore is ineffective.
• Levodopa is a chemical formulation found in plants
and animals that is converted into dopamine by
nerve cells in the brain.
• Combining levodopa with another drug (carbidopa)
causes more levodopa to reach the brain.
• The mechanism of action of amantadine and
selegiline in the treatment of parkinsonism is not
fully understood.
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 .
• selegiline or pergolide may be added to the
drug regimen of those being treated with
carbidopa and levodopa.

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 ACTIONS
• Dopamine, when given orally, does not cross the
blood–brain barrier and therefore is ineffective.
• Levodopa is a chemical formulation found in plants
and animals that is converted into dopamine by
nerve cells in the brain.
• Combining levodopa with another drug (carbidopa)
causes more levodopa to reach the brain.
• The mechanism of action of amantadine and
selegiline in the treatment of parkinsonism is not
fully understood.
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 ACTIONS
• selegiline or pergolide may be added to the
drug regimen of those being treated with
carbidopa and levodopa.

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 ADVERSE REACTIONS
• During early treatment with levodopa and
carbidopa, adverse reactions are usually not a
problem.
• But as the disease progresses, the response to
the drug may become less, and the period of
time that each dose is effective begins to
decrease, leading to more frequent doses, and
more adverse reactions.

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 ADVERSE REACTIONS
• The most serious and frequent adverse reactions seen with
levodopa include choreiform movements (involuntary
muscular twitching of the limbs or facial muscles) and
dystonic movements (muscular spasms most often affecting
the tongue, jaw, eyes, and neck).
• Less common but serious reactions include mental changes,
such as depression, psychotic episodes, paranoia, and suicidal
tendencies.
• Common and less serious adverse reactions include anorexia,
nausea, vomiting, abdominal pain, dry mouth, difficulty in
swallowing, increased hand tremor, headache, and dizziness.

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 ANTICHOLINERGIC DRUGS
• Drugs with anticholinergic activity inhibit
acetylcholine (a Neurohormone produced in
excess in Parkinson’s disease) in the CNS.

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 COMT INHIBITORS
catechol-O-methyltransferase

• ACTIONS:
– These drugs are thought to prolong the effect of levodopa by
blocking an enzyme, catechol-O-methyltransferase (COMT),
which eliminates dopamine.
• ADVERSE REACTIONS:
– Disorientation, confusion, light-headedness, dizziness,
dyskinesias, hyperkinesias, nausea, vomiting, hallucinations,
and fever, orthostatic hypotension, sleep disorders, excessive
dreaming, somnolence, and muscle cramps.
– liver failure can occur with the administeration of tolcapone.

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NURSINGPROCESS

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 Educating the Patient and Family
The nurse should include the following information in the patient and family teaching plan:

• Do not increase, decrease, or omit a dose or stop taking the drug unless
advised to do so by the primary health care provider. If gastrointestinal
upset occurs, take the drug with food.
• If dizziness, drowsiness, or blurred vision occurs, avoid performing tasks
that require alertness.
• Avoid the use of alcohol.
• Relieve dry mouth by sucking on hard candy or frequent sips of water.
• Inform patients that orthostatic hypotension.
• Notify the primary health care provider if any of these problems occur:
severe dry mouth, inability to chew or swallow food, inability to urinate,
feelings of depression, severe dizziness or drowsiness, rapid or irregular
heartbeat, abdominal pain, mood changes, and unusual movements of
the head, eyes, tongue, neck, arms, legs, feet, mouth, or tongue.
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 Preadministration Assessment
• Nurse obtains the health history from a family
member.
• Information regarding the symptoms of the
disorder, the length of time the symptoms
have been present, the ability of the patient to
carry on activities of daily living, and the
patient’s current mental condition.

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 Ongoing Assessment
• The nurse evaluates the patient’s response to
drug therapy by neurologic observations.
• patient is assessed for clinical improvement of
the symptoms of the disease, such as
improvement of tremor of head and/or hands
at rest, muscular rigidity, mask-like facial
expression, and ambulation stability.

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• When taking levodopa, avoid vitamin B6.
• Patients with diabetes:
• Levodopa may interfere with urine tests for
glucose or ketones.

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Trigeminal Neuralgia and Anti Migraine

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 Objectives
At the end of this topic students will be able
to,
• Explain trigeminal neuralgia.
• Discuss the action, contraindication and side effects of drugs
used in migraine and trigeminal neuralgia.
• Identify most commonly used drugs for migraine and trigeminal
neuralgia.
• State the major nursing care if client is using drug against
migraine and trigeminal neuralgia.
• Calculate the drug dosage accurately for oral anti migraine and
drugs for trigeminal neuralgia.

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 Trigeminal Neuralgia
• Momentary episodes of sudden lancinating facial
pain occur and commonly arise near one side of the
mouth and shoot toward the ear, eye, or nostril on
that side.

• Essentials of Diagnosis
– Brief episodes of stabbing facial pain.
– Pain is in the territory of the second and third division of
the trigeminal nerve.
– Pain exacerbated by touch.

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 Trigeminal Nerves
• The trigeminal
nerve (the fifth
cranial nerve,
also called the
fifth nerve, or
simply CNV or
CN5) is
responsible for
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 Drugs used for Trigeminal Neuralgia

Medications

Medications to lessen or block the pain signals sent

to your brain are the most common initial
treatment for trigeminal neuralgia.

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 Anticonvulsants
• Carbamazepine (Tegretol, Carbatrol) is the
drug most commonly prescribed — and with
the most demonstrated effectiveness — for
trigeminal neuralgia.
• Other anticonvulsant drugs used to treat
trigeminal neuralgia include oxcarbazepine
(Trileptal), lamotrigine (Lamictal), phenytoin
(Dilantin, Phenytek) and gabapentin
(Neurontin).
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• If the anticonvulsant you're using begins to
lose effectiveness, doctor may increase the
dose or switch to another type.
• Side effects of anticonvulsants may include
dizziness, confusion, drowsiness, double vision
and nausea.

• Also, carbamazepine can trigger a serious drug

reaction in some people, mainly those of
Asian descent, so genetic testing may be
recommended before you start
carbamazepine.
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 Antispasmodic Agents
• Muscle-relaxing agents such as baclofen may
be used alone or in combination with
carbamazepine or phenytoin.
• Side effects may include confusion, nausea
and drowsiness.

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 Surgery
The goal of surgery for trigeminal
neuralgia is either to stop the
blood vessel from compressing the
trigeminal nerve or to damage the
trigeminal nerve to keep it from
malfunctioning.
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 Anti migraine
• What is migraine?

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 Anti Migraine
• What is migraine?

– A migraine headache is a form of vascular headache.

Migraine headache is caused by enlargement of those
blood vessels stretches the nerves that coil around them
and causes the nerves to release chemicals. The chemicals
cause inflammation, pain, and further enlargement of the
artery. The increasing enlargement of the arteries
magnifies the pain.

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 Treatment of Acute Migraine
• A simple analgesic such as aspirin, paracetamol
(preferably in a soluble or dispersible form) or an
NSAID is often effective.
• Concomitant anti-emetic treatment may be required.

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 5HT1 Agonists
• The 5HT1 agonists available for treating
migraine are almotriptan, eletriptan,
frovatriptan, naratriptan, rizatriptan,
sumatriptan, and zolmitriptan.
• Cautions:
– 5HT1 agonists should be used with caution in conditions
which predispose to coronary artery disease.
– hepatic impairment.
– Pregnancy.
– breast-feeding .

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 Side-Effects
• Side-effects of the 5HT1 agonists include
sensations of tingling, heat, heaviness,
pressure, or tightness of any part of the body
(including throat and chest—discontinue if
intense, may be due to coronary
vasoconstriction ).

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 Anti-Emetics
• Anti-emetics, such as metoclopramide or
domperidone, or phenothiazine and
antihistamine anti-emetics, relieve the nausea
associated with migraine attacks.

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Skeletal Muscle Relaxants

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 Objectives
at the end of this topic students will be able
to:
• Identify common symptoms/disorders or which skeletal muscle
relaxants are used.
• Describe uses & effects of skeletal muscle relaxants.
• Differentiate between centrally acting & peripherally acting
muscle relaxants.
• Describe non-pharmacologic interventions to relieve muscle
spasm & spasticity.
• Apply the nursing process with clients experiencing muscle
spasm

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 Skeletal Muscle Relaxants
• Skeletal muscle relaxants are used in various
acute, painful musculoskeletal conditions,
such as muscle strains and back pain due to
spam or spasticity.

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• Drugs that affect skeletal muscle, function as
two very different therapeutic groups,

– Those used during surgical procedures and in

intensive care units to produce muscle paralysis
for patients requiring ventilatory assistance (ie,
neuromuscular blockers).
– Neuromuscular blocking drugs interfere with transmission at
the neuromuscular end plate and lack central nervous system
activity.
– Those used to reduce spasticity in a variety of
neurologic conditions (ie, spasmolytics).
– Drugs in the spasmolytic group have traditionally been called
"centrally acting" muscle relaxants and
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Uses of Skeletal Muscle Relaxants
• During surgical procedures.
• In intensive care units to produce muscle paralysis for
patients requiring ventilatory assistance.
• To reduce spasticity in a variety of neurologic
conditions.
• As adjuncts during general anesthesia to facilitate
tracheal intubation and optimize surgical conditions.
• To treat chronic back pain and fibromyalgic
conditions.

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NEUROMUSCULAR BLOCKING DRUGS

All of the
available
neuromuscular
blocking drugs
bear a structural
resemblance to
acetylcholine.

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• Tubocurarine.
• Succinylcholine.
• Atracurium.
• Cisatracurium.

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Pharmacokinetics of Neuromuscular
Blocking Drugs

All of the neuromuscular blocking drugs are

highly polar and inactive orally and must be
administered parenterally.

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 NURSINGPROCESS
• Preadministration Assessment:
– For the physical assessment, the nurse generally
appraises the patient’s physical condition and
limitations.
– Vital signs and weight are taken to provide a
baseline for comparison during therapy.

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• Ongoing Assessment:
– Periodic evaluation is an important part of therapy
for musculoskeletal disorders.
– The nurse questions the patient regarding the
relief of pain, as well as adverse drug reactions.

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