Pharmacology- 09/03/2019

Johan S. Macapar, R.N., M.A.N. 2. Benziodapines

- Anxiolytic/ anti-anxiety medications
- for anxiety and sleep disorders
INSOMNIA - pre-op meds
- a sleep disorder that is characterized by - muscle relaxants, anti convulsants
difficulty falling and/or staying asleep - inhibit the action of inhibitory neurotransmitter
- symptoms GABA
o difficulty falling asleep - reduces neuron excitability
o waking up often during the night and - examples
having trouble going back to sleep o Diazepam (valium)
o waking up too early in the morning o Flurazepam (dalmane)
o feeling tired upon waking up o Lorazepam (Ativan)
- Primary Insomnia o Triazolam (Halcion)
o not directly associated with any other o Alprazolam
health condition or problem o Temazepam
- Secondary Insomnia o Estazolam
o due to health condition (like asthma, o Quazepam
depression, cancer, or heartburn); pain; o Chlordiazepoxide (Librium)
medication they are taking; or a
substance they are taking - Nursing Considerations
o Prepare flumanzil as an antidote for
1. Barbiturates overdose
- Long acting o Avoid driving of car or operating
o Phenobarbital hazardous machinery
 high chance of dependence and o Short-term use to prevent tolerance and
tolerance dependence
 use to control seizures o Increase chances of anterograde
o Mephobarbital amnesia
o Toner slowly the dose and frequency
- Intermediate Acting o High fiber diet
o Butabarbital o Encourage not to drink liquor during
 useful as sleep sustainer for therapy
maintaining long periods of o Avoid giving drugs with tobacco,
sleep antacids during pregnancy.

- Short-acting Benziodapine Antagonist

o Secobarbital - Flumanzil
 for procedure sedation - inhibits the activity of benzodiazepine in the
receptor site of the GABa/benzodiazepine
- Nursing Management receptor complex.
o Monitor V/S - reverses the binding of the benzodiazepine to
o Observe for drug tolerance benzodiazepine receptors
o Refer for signs of withdrawal (tremors, - for complete or partial reversal of the sedative
dizziness) effects of benzodiazepines in conscious sedation
o Prohibit driving of car or operating and general anesthesia in adult and pediatric
hazardous machineries populations
o High fiber diet
o Encourage not to drink liquors Zolpidem Tartrate
o Use at nighttime - non benzodiazepines
o Short term use (<2weeks) - short term (<10 days) treatment of insomnia
 - neurotransmitter inhibition = CNS depression
- 6 to 8 hours duration of action
Ramelton
- melatonin agonist
- non controlled substance
- selectively targeting melatonin receptors to
regulate circadian rhythm in the treatment of
insomnia
# 3. Field block
ALCOHOL
- a psychoactive substance with dependence-
producing properties
- worldwide, 3 million deaths every year result
from harmful use of alcohol, this represent 5.3%
of all deaths (WHO, 2018)
- the impact of alcohol concumption on chronic
and acute health outcomes in populations is
largely determined by 2 separate but related
dimensions of drinking
o the total volume of alcohol consumed
o the pattern of drinking
Disulfiram (antabuse)
- anti alcoholic agent
- cause unpleasant reaction when combined with
alcohol
o headache, dizziness, sweating,
palpitation, and hypotension
- use as last recourse
- Nursing Management
o Avoid alcohol
 reaction begins 5 to 10 minutes
if combined and is equal to
amount of alcohol ingested
o Best taken 12 hours after abstaining
from alcohol
o No alcohol containing substances
 mouthwashes, liniments, OTC
cold remedies, menthol, after
shave lotion, vinegar
o Monitor liver function
Nalmefene
- stops ‘feel good effects of alcohol
- makes you drink less
- does not prevent intoxication
- anti-alcohol drug
#
ANESTHETICS
5 types
1. Topical Administration
- involves applying a cream, lotion,
ointment, or local anesthetics to
traumatized-skin to relieve pain
2. Infiltration
- injecting it directly into the tissues to be
treated ( ex. sutured, drilled, cut)
- injecting it all around the area that will
be affected by the operation ( ex. tooth
extraction)
4. Nerve Block
- injecting it at some point along the nerve
or the nerves that run to or from the
region where loss of pain sensation or
muscle paralysis is desired
- regional anesthesia, popliteal block,
lateral approach
5. ?
Spinal anesthesia positioning:
- sitting position
- inserted below the level of the spinal
cord
Epidural Block
- is the placement of the local anesthetic
in the epidural space just posterior to the
spinal cord or the dura mater
Caudal block
- is an epidural block placed by placing a
local anesthetic through the sacral hiatus
Local Anesthetics
1. Procaine HCL (novocaine)
- short acting, 30 minutes to 1 hour
2. Lidocaine (xylocaine)- Amide Group
- moderate acting, 1 to 3 hours
3. Bupivacaine (macaine)
- amide group
- long acting, 3 to 10 hours
General Anesthetics
- depress the CNS, alleviate pain, and
cause loss of consciousness
- it can also lead to loss of awareness of
one’s surroundings and amnesia
 Moderate Deep
Minimal General
Description Sedation/ Sedation/Anal
Sedation Anesthesia
Analgesia gesia

Responsive- Normal Purposeful Purposeful No

ness response to response to response to responsivene
verbal verbal or repeated or ss with
stimulation tactile purposeful painful
stimulation stimulation stimulation
Airway unaffected No Intervention Intervention
intervention may be often
required required required
Spontan-eous Unaffected Adequate Maybe Frequently
Ventilation adequate adequate

Cardiovas- unaffected Usually Usually May be

cular maintained maintained impaired
Function

Inhalation Anesthetics
- use during the third stage to deliver
anesthesia
- ex. gas or volatile liquids administered
as gas
A. Anesthetic Gas
1. Nitrous Oxide
- Blue cylinder
2. Cyclopropane
- Orange cylinder
3. Ethylene
- Red cylinder
B. Volatile Liquids
1. Halothane (fluothane)
2. Desulfrane (suprane)
3. Enflurane (ethrane)

Intravenous Anesthetics
1. Droperidol (innovar)
2. Etoidate (amidate)
3. Ketamine HCl (ketalar)
4. Midozalam (dormicum)
- for induction and maintenance
of anesthesia