Central Nervous System

Composed of all nerves within the brain and spinal cord; integrates/deciphers incoming nerve messages and sends responses to the organs and tissues of the body; coordinates muscle movements, visualization, temperature regulation, pain, and other sensations

CNS Drug

Any drug that effects the brain and/or spinal cord

Dependance

Altered state where continued administration of a drug is necessary to prevent physical and psychological withdrawl symptoms

Addiction

A pattern of compulsive use characterized by overwhelming involvement with drug use and abuse

Tolerance

9 Therapeutic Classes: CNS Drugs

Sedative Hypnotics

Short term use only; tx insomnia; long-term use can cause drug-induced abnorm. in pt. hs; antidotes for overdoses of stimulatns; often used in combination w/ analgesics in painful situations; used as pre-op anesthetics

Mech. of Act: unsure; thought to reduce brain/spinal cord activity

S.E.: drowsiness, addiction, tolerance & dependance, respiratory & cardiac depression (w/ hi doses)

Three Classes of Sed. Hyp.

Benzodiazepines, barbituates, and miscellaneous

Flurazepam (Dalmane)

Sedative Hypnotic: Benzodiazepine

Alprazolam (Xanax)

Sedative Hypnotic: Benzodiazepine

Lorazepam (Ativan)

Sedative Hypnotic: Benzodiazepine

Diazepam (Valium)

Sedative Hypnotic: Benzodiazepine

Also: Skeletal Muscle Relaxant

Oxazepam (Serax)

Sedative Hypnotic: Benzodiazepine

Midazolam (Versed)

Sedative Hypnotic: Benzodiazepine

Temazepam (Restoril)

Sedative Hypnotic: Benzodiazepine

Triazolam (Halcion)

Sedative Hypnotic: Benzodiazepine

Secobarbital (Seconal)

Sedative Hypnotic: Barbituate

Amobarbital (Amytal)

Sedative Hypnotic: Barbiturate

Penobarbitol (Nembutal)

Sedative Hypnotic: Barbiturate

Primidone (Mysoline)

Sedative Hypnotic: Barbiturate

Zolpidem Tartrate (Ambien)

Sedative Hypnotic: Miscellaneous

Chloral Hydrate (Noctec)

Sedative Hypnotic: Miscellaneous

Alcohol

Sedative Hypnotic: Miscellaneous

Diphenhydramine (Benadryl, Compoz, Nytol, Sominex)

Sedative Hypnotic: Miscellaneous

Skeletal Muscle Relaxant

Relieves muscle spasm assoc. w/ muscle inflammation & injury; useful in neuromuscular disorders (i.e. MS & CP)

Mech. of Act: Not understood; may block nerve response within spinal column; reduces muscle tone & relives muscle spasm and tension

S.E.: Drowsiness, addiction, tolerance and dependance, respiratory/cardiac depression (w/ hi doses)

Cyclobenzaprine (Flexeril)

Skeletal Muscle Relaxant

Methocarbamol (Robaxin)

Skeletal Muscle Relaxant

Baclofen (Lioresal)

Skeletal Muscle Relaxant

Chlorzoxazone (Parafon Forte)

Skeletal Muscle Relaxant

Anticonvulsants

tx epilepsy; needs to be individualized by dose and addition of other anticonvulsant agents; prevents ocurrence of siezures; does not cure the disease

Mech of act: control the excessive discharge of signals from the brain (siezures)

S.E.: Drowsiness, slurred speech, addiction, tolerance and dependance, respiratory/cardiac depression (w/hi doses)

Epilepsy

Seizures accompanied by loss ordisturbance of consciouness and possibly abnormal body movements (convulsions)

Determinants of Anticonvulsant Agent Chosen

Carbamazepine (Tegretol)

Anticonvulsant

Valproic acid and it's derivatives (Depakene, Depakote)

Anticonvulsant

Gabapentin (Neurontin)

Anticonvulsant

Lamotrigine (Lamictal)

Anticonvulsant

Clonazepam (Klonopin)

Anticonvulsant

Clorazepate (Tranxene)

Anticonvulsant

Ethosuximide (Zarontin)

Anticonvulsant

Narcotic Analgesics

Use: Relieve mod. to severe pain, cough suppressant, severe diarrhea

Mech. of act: bind to specific receptors within brain and depress certain parts of CNS to cause pain relief, respiratory depression, decreased GI motility, and cough suppression

S.E.: Drowsiness, constipation, N&V, addiction, tolerance and physical & psychological dependance, OD (can cause resp. depression, profound coma, & pinpoint pupils (narcotic antagoinsts used to treat OD (i.e. Naloxone (Narcane))));

Can be used as single agents or in combination

Codeine

Single Agent Narcotic Analgesic

Morphine Sulfate (MS Contin, Roxanol)

Single Agent Narcotic Analgesic

Oxycodone (Roxicodone)

Single Agent Narcotic Analgesic

 Nalbuphine (Nubain)

Single Agent Narcotic Analgesic

Meperidine (Demerol)

Single Agent Narcotic Analgesic

Fentanyl (Duragesic)

Single Agent Narcotic Analgesic

Hydromorphone (Dilaudid)

Single Agent Narcotic Analgesic

Remifentanil (Ultiva)

Single Agent Narcotic Analgesic

Pentazocine (Talwin)

Single Agent Narcotic Analgesic

Levorphanol (Levo-Dromoran)

Single Agent Narcotic Analgesic

Propoxyphene (Darvon)

Single Agent Narcotic Analgesic

Butorphanol (Stadol)

Single Agent Narcotic Analgesic

Acetaminophen with Codeine (Tylenol with Codeine)

Combination Product Narcotic Analgesic

Hydrocodone and APAP (Lorcet, Lortab, Vicodin)

Combination Product Narcotic Analgesic

Propoxyphene and APAP (Darvocet-N, Propacet, Wygesic)

Combination Product Narcotic Analgesic

Oxycodone and APAP (Percocet, Roxicet)

Combination Prodcut Narcotic Analgesic

Oxycodone and ASA (Percodan)

Combination Product Narcotic Analgesic