PHARMACOLOGY

2
ELENITA C. MANRIQUE – ARREGLO, RN, MD, MHA
 NEUROPHARMACOLOGY

•  REVIEW ON NEUROPHYSIOLOGY
•  NEURONS AND NERVE ACTION POTENTIAL
•  ELECTRICAL NATURE
•  CHEMICAL NATURE
•  NEUROTRANSMITTERS
•  EXCITATORY NEUROTRANSMITTERS
•  INHIBITORY NEUROTRANSMITTERS

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ANXIOLYTIC DRUGS

•  SEDATIVE HYPNOTIC
•  Mechanism of action – to enhance the effect of GABA (Gamma Amino
Butyric Acid), an inhibitory neurotransmitter to decrease impulses in the
synapses of the brain, therefore decreasing conduction of rapid impulses
causing symptoms of anxiety.

https://www.verywellmind.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147
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ANXIOLYTIC DRUGS

•  Barbiturates – drug action is to enhance GABA effect. This is used to be the drug of
choice to manage anxiety but its depressant effect may cause severe respiratory
depression that this is not primarily used for anxiety today
•  Phenobarbital, Secobarbital, Amobarbital

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ANXIOLYTIC DRUGS

•  Benzodiazepines – drug action is to enhance GABA effect to cause inhibition of impulse

transmission.
•  Examples: Diazepam, Lorazepam, Clonazepam, Chlordiazepoxide

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ANXIOLYTIC DRUGS

•  Non – Benzodiazepines
•  Paraldehyde, Meprobamate, Chloral hydrate, Zolpidem, Diphenhyramine

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 ANXIOLYTIC HYPNOTIC DRUGS

q Nursing Considerations
q Avoid abrupt discontinuation after prolonged use
q Not given if BP is elevated, with renal/hepatic dysfunction, or history of drug abuse
q Xanax (Alprazolam), Ativan (Lorazepam), Serax ( Oxazepam ) - examples with brand names
q Increase in 3Ds - drowsiness, dizziness, and decrease in BP
q Enhance action of GABA
q Teach to rise slowly from supine
q Yes, alcohol and caffeine should be avoided
 ANTIPSYCHOTIC DRUGS

https://www.independent.co.uk/life-style/health-and-families/health-news/fall-in-violent-crime-could-be-down-to-antipsychotic-drugs-says-mental-health-expert-9334346.html
 ANTIPSYCHOTIC DRUGS

•  TYPICAL ANTIPSYCHOTIC DRUGS

•  block Dopamine receptors in the limbic system, in the reticular activating system and
the brain. This group of antipsychotic may block all dopamine receptors including those
not associated with psychoses
•  ATYPICAL ANTIPSYCHOTIC DRUGS
•  – block Dopamine and Serotonin receptors. This group will lock only the receptors of
Dopamine and Serotonin which are responsible for occurrence of psychosis making
them more specific drugs for Psychotic disorders
 DOPAMINE RECEPTORS

Mane, A. (2017) dopamine receptors: retrieved fro,https://www.slideshare.net/AmbadasMane2/dopamine-72507519

https://alchetron.com/5-HT-receptor#5-ht-receptor-fbd1c8c1-22f8-4dea-817e-be79c27d752-resize-750.jpeg
 TYPICAL ANTIPSYCHOTIC DRUGS

•  Typical Antipsychotic drugs: Older drugs, they are less potent and associated with
more adverse effects
•  Examples: Chlorpromazine, Fluphenazine, Thioridazine, Haloperidol
 ATYPICAL ANTIPSYCHOTIC DRUGS

•  Typical Antipsychotic drugs: Older drugs, they are less potent and associated with
more adverse effects
•  Examples: Chlorpromazine, Fluphenazine, Thioridazine, Haloperidol
 ANTIPSYCHOTIC DRUGS

q Adverse Effects
q Sedation/Sunlight sensitivity
q Tardive dyskinesia, Tachycardia, and Tremors
q Anticholinergic, Agranulocytosis, Addiction
q NMS ( Neuroleptic Malignant Syndrome )
q Cardiac symptoms (orthostatic hypotension),
q EPS ( Extra pyramidal syndrome )
q Endocrine (change in libido)
EXTRA PYRAMIDAL SYMPTOMS

https://www.pinterest.ph/pin/857865428989492668/
 Neuroleptic Malignant Syndrome
q Rigidity
q High fever
MNEMONICS
q Autonomic instability F – FEVER
q Unstable BP E – ENCEPHALPATHY
V – VITALS UNSTABLE
q Diaphoresis E – ELEVATED ENZYME (CPK)
q Pallor R – RIGIDITY OF MUSCLES

q Delirium
q Elevated enzymes:
q creatinine and phosphokinase
q Mute
q Agitation to stupor
 NMS Management

q Treatment:
q STOP all antipsychotic agents
q Supportive medical care
 ANTI SEIZURE DRUGS

Price, S. Antiseizure drugs (2019) Retrieved from: https://www.healtheuropa.eu/nih-study-anti-seizure-drugs-for-epilepsy/95318/

 ANTI SEIZURE DRUGS

•  Mechanisms of Action
•  Suppressing sodium influx or deporalarization in the neuron
•  Suppressing calcium influx, preventing electric current generated by calcium
ions
•  Increasing the action of the Gamma Amino Butyric Acid ( GABA ) an
inhibitory neurotransmitter in the brain
 ANTI SEIZURE DRUGS

(A picture depicting a synapse showing neurotransmitters from the presynaptic neurons and receptors at the post synaptic neuron) Retrieved from
https://www.ck12.org/biology/nerve-impulse/lesson/Nerve-Cells-and-Nerve-Impulses-MS-LS/
 ANTI SEIZURE DRUGS

http://tmedweb.tulane.edu/pharmwiki/lib/exe/fetch.php/antiseizure_drugs.png?cache=
 NURSING CONSIDERATIONS

q Nursing Considerations
•  CNS: dizziness, insomnia
•  Antacids decrease
•  Eat food with drug
•  Support group for epileptics
•  Alert tag indicating specific drug
•  Report adverse effects
 ANTI PARKINSON’S DRUGS

https://www.drugoffice.gov.hk/eps/do/en/consumer/news_informations/dm_24.html
 DOPAMINERGIC DRUGS

•  Dopaminergic drugs – increase the effect of Dopamine at the receptor sites by

increasing the levels of dopamine in the substantia nigra or directly stimulating the
receptors
•  Levodopa with Carbidopa, Amantadine, Bromocriptine
 ANTICHOLINERGIC DRUGS

•  oppose the effects of acetylcholine at receptor sites in the substantia nigra.

These anticholinergic drugs have greater affinity with the receptors of
acetylcholine in the CNS than those in the periphery. However, they still
block some receptors at the autonomic nervous system. Blocking the
acetylcholine effect help to normalize the dopamine – acetylcholine
imbalance in the basal ganglia.
•  Diphenhydramine ( Benadryl ), Benztropine ( Cogentin ), Biperiden ( Akineton )
Trihexyphenidyl ( Artane )
 ANTI PARKINSON’S DRUGS

q Dopaminergics
q Levodopa

q Nursing Considerations
q Give the drug with meals
q Monitor bowel function
q Instruct to void before taking the drug
q Inform about relapse
 ANTI PARKINSON’S DRUGS
q Anticholinergics
q Benztropine (Cogentin)
q Biperiden (Akineton)
q Trihexyphenidyl (Artane)
q Nursing Considerations: Avoid alcohol, eat sugarless candy, use sunglasses
q Dopamine Agonists
•  Amantadine (Symmetrel)
•  Bromocriptine (Parlodel)
•  Pergolide (Permax)
q Nursing Considerations: Slowly rise from supine to standing position, avoid alcohol
 MUSCLE RELAXANTS

https://www.epainassist.com/opioid-treatment/medications/what-is-muscle-relaxer-and-list-of-common-
muscle-relaxants
https://www.google.com/search?
q=centrally+acting+muscle+relaxant+drugs&source=lnms&tbm=isch&sa=X&ved=2ahUKEwj_gMmQqpXpAhXayosBHSR6DUYQ_AUoAXoECA0QAw&biw=1280&bih=561#imgrc=IJZa2c7
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 NMJ BLOCKERS

•  1. NON DEPOLARIZING NMJ BLOCKERS

•  2. DEPOLARIZING NMJ BLOCKERS
 NMJ BLOCKERS

Bansal, P. NMJ blockers, Retrieved from https://www.slideshare.net/drpranav1/skeletal-muscle-relaxants-

neuromuscular-blocking-agents-neuromuscular-blockers
 SPASMOLYTICS

•  1. CENTRALLY – ACTING MUSCLE RELAXANTS

•  2. DIRECT ACTING SKELETAL MUSCLE RELAXANTS
CENTRALLY – ACTING MUSCLE RELAXANTS

•  DIRECTLY SUPPRESS MOTOR NEURONS IN THE CNS

•  BACLOFEN, ORPHENADRINE, TIZANIDINE
 DIRECT ACTING SKELETAL MUSCLE
RELAXANTS

•  DECREASE THE RELEASE OF CALCIUM THE SKELETAL MUSCLES

•  DANTROLENE, BOTULINUM TOXIN B
 SPASMOLYTICS

q Centrally-acting Muscle Relaxants

q Baclofen (Lioresal)

q Nursing Consideration:
q Monitor respiratory status
q NO ALCOHOL
 SPASMOLYTICS

q Direct Acting Skeletal Muscle Relaxants

q Dantrolene sodium (Dantrium)
q Nursing Consideration:
q  STOP if diarrhea becomes severe