Comprehensive and detailed exam 4 Summarized Lecture notes including slideshow notes, in class notes, images, drug charts, tophat questions, etc covering topics of CNS drugs, NSAIDs, and acetaminophen for Nur 243.
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Central Nervous System: Chapter 23 + 31
● CNS drugs
○ Agents that act on the brain and spinal cord
○ Medical uses
■ Relief of pain
■ Suppression of seizures
■ Production of anesthesia
■ Treatment of psychiatric disorders
○ Nonmedical uses
■ Stimulant
■ Depressant
■ Euphoriant
■ Other “mind-altering” abilities
● Chapter 23 key topics
○ Overview of neurotransmitters in the CNS
○ How CNS drugs produce their therapeutic effect
○ Adaptation of the CNS to prolonged drug exposure
● CNS versus PNS
○ Peripheral nervous system
■ Neurotransmitters-limited to 3
● Adrenergic & Cholinergic receptors
● Subdivisions
■ Therapeutic Response results from Synaptic function
○ Central nervous system
■ Neurotransmitters
● At least 21
■ No subdivision
■ Blood brain barrier
■ Therapeutic Response/prolong drug exposure results from adaptive
function
● Adaptation of the CNS to prolonged drug exposure
○ Responses of a drug may be delayed because they result from adaptive changes
and not from the direct effects of drugs on synaptic function. Full therapeutic
effects are not seen until the CNS has had time to modify itself in response to
prolonged drug exposure. Beneficial responses may be delayed because they
, result from adaptive changes and not from the direct effects of drugs on synaptic
function
○ Results of adaptive changes during prolonged exposure
■ Increased therapeutic effect
● Full therapeutic effects are not seen until the CNS has had time to
modify itself in response to prolonged drug exposure
■ Decreased side effects
● When CNS drugs are taken chronically, the intensity of the side
effects may decrease, but the therapeutic effects remain
undiminished
○ Special manifestations of CNS
■ Tolerance
● Decreased response occurring during the course of prolonged drug
use
■ Physical dependence
● State in which abrupt discontinuation of drug use will precipitate a
withdrawal syndrome
● Central Nervous System Opioids: Chapter 31
○ Opioid analgesics
○ Opioid antagonists
● Threaded clinical case study
○ Paul is a 49-year-old male with a complaint of “dull, aching pain” in his left knee
for 5 months. He is referred to an orthopedic surgeon who recommends a total left
knee replacement following the interview, physical exam, and review of
diagnostic imaging.
Paul was a football player in high school and college and states “I am well aware
of the extensive osteoarthritis in my knees, I have been holding off as long as
possible for the surgery.”
PMH: DM—type 2, intermittent lower back pain, and osteoarthritis
Current medications: metformin--850mg PO twice daily, 1 baby aspirin daily, and
over the counter naproxen and acetaminophen –as need for left knee pain.
The left total knee replacement proceeds without any complications. On arrival to
the unit Paul reports his pain is a number 9. He is prescribed hydromorphone 2mg
IV every 2 to 3 hours prn severe pain, percocet 5mg/325mg 2 tablets PO every 6
hours for moderate pain, and a sliding scale insulin of lispro SC based on blood
glucose level.
○ Questions to consider
■ Discuss the physiological effects of opioids?
■ Differentiate the various classes of opioids agonist and antagonists.
, ■ Discuss the medication you would administer and the associated nursing
strategies to ensure safe and effective patient centered care.
■ Distinguish between drug tolerance and physical dependency.
● Objectives
○ Upon completion of the class/learning activities the student will:
○ 1. Distinguish between the 3 classes of opioid receptors
○ 2. Describe the pharmacology of opioids.
○ 3. Discuss the clinical/therapeutic use of opioids.
○ 4. Distinguish between opioid agonist and opioid antagonist.
○ 5. Discuss the adverse effects of opioids and opioid antagonist.
○ 6. Examine physical and psychological dependence and related issues.
● Endogenous opioid peptides + receptors
○ Three families of peptides
■ Enkephalins
, ■ Endorphins
■ Dynorphins
○ Three main classes of opioid receptors:
■ Mu
■ Kappa
■ Delta
● Opioid receptors
○ Three main classes of opioid receptors:
■ Mu receptors: Analgesia, respiratory depression, euphoria, sedation,
decreased gastric motility, and physical dependence
■ Kappa receptors: Analgesia, sedation, and decreased gastric motility
■ Delta receptors
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