Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Psychotherapeutic Agents

Psychotherapeutic Agents

Psychotherapeutic Agents

  • Used to treat psychoses: perceptual and behavioral disorders
  • Drugs do not cure psychoses: they help patients function in a more acceptable manner and carry on activities of daily living
  • Used in both children and adults

Mental Disorders and Their Classifications

  • Schizophrenia
  • Mania/bipolar disease
  • Narcolepsy
  • Attention-deficit disorder

Schizophrenia

  • Characteristics
    • Hallucinations, paranoia, delusions, speech abnormalities, and affective problems
  • Causes
    • Strong genetic association
    • May reflect a fundamental biochemical abnormality

Mania/Bipolar Illness

  • Characteristics
    • Mania: periods of extreme overactivity and excitement
    • Bipolar illness: extremes of depression followed by hyperactivity and excitement
  • Cause
    • May reflect a biochemical imbalance followed by overcompensation on the part of neurons and their inability to re-establish stability

Narcolepsy

  • Characteristics
    • Daytime sleepiness and sudden periods of loss of wakefulness
  • Causes
    • Problems with stimulation of the brain by the reticular activating system (RAS)
    • Problems with response to that stimulation

Characteristics of Attention-Deficit Disorders

  • Inability to concentrate on one activity for longer than a few minutes
  • State of hyperkinesis
  • Usually diagnosed in school-age children but can occur in adults

Sites of Action of the Drugs Used to Treat Mental Disorders

Sites of Action of the Drugs Used to Treat Mental Disorders
Sites of Action of the Drugs Used to Treat Mental Disorders

 

 

Classifications of Antipsychotics

  • Typical
    • Primarily dopamine receptor blockers
    • Cause several adverse effects including hypotension, anticholinergic effects, and extrapyramidal side effects (EPS)
  • Atypical
    • Block both dopamine receptors and serotonin receptors
    • May alleviate some of the unpleasant neurological effects and depression caused by typical antipsychotics

Types of Extrapyramidal Effects

  • Pseudoparkinsonism
  • Dystonia
  • Akathisia
  • Tardive dyskinesia
  • Potentially irreversible neuroleptic malignant syndrome

Antipsychotic/Neuroleptic Drugs

  • Actions
    • Typical antipsychotic drugs block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine
    • Depress the RAS, limiting the stimuli coming into the brain
    • Atypical antipsychotics block both dopamine and serotonin receptors
  • Indications
    • Schizophrenia, hyperactivity, combative behavior, agitation in the elderly, and severe behavioral problems in children
  • Pharmacokinetics
    • Absorbed from the GI tract
    • IM dose provides 4 to 5 times the active dose as oral doses
    • Widely distributed in the tissues
    • Metabolized in the liver
    • Excreted through bile and urine
    • Cross placenta and enter breast milk
  • Contraindications
    • Underlying diseases that could be exacerbated by the dopamine-blocking effects of these drugs
    • CNS depression
    • Circulatory collapse
    • Parkinson’s disease
    • Coronary disease
    • Severe hypotension
    • Prolonged QT interval
  • Adverse reactions
    • Sedation
    • Weakness
    • Tremors
    • Drowsiness
    • Extrapyramidal effects
    • Dry mouth
    • Nasal congestion
    • Constipation
  • Drug-to-drug interactions
    • Beta blockers, alcohol, mesoridazine, thioridazine

Drugs Used to Treat Mania/Bipolar Disease

  • Lithium salts (Lithane, Lithotabs)
  • Lamotrigine (Lamictal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)

Action of Lithium

  • Alters sodium transport in nerve and muscle cells
  • Inhibits the release of norepinephrine and dopamine—but not serotonin—from stimulated neurons
  • Increases the intraneuronal stores of norepinephrine and dopamine slightly
  • Decreases intraneuronal content of second messengers

Antimanic Drugs

  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 30 minutes
    • Same distribution pattern in the body as water
    • Slowly crosses the blood–brain barrier
    • Excreted from the kidney, 80% is reabsorbed
    • Crosses the placenta: associated with congenital abnormalities
    • Enters the breast milk
  • Contraindications
    • Known allergy, renal or cardiac disease, leukemia, metabolic disorders, pregnancy, and lactation
  • Adverse reactions
    • Effects directly related to the lithium serum level
      • Levels less than 1.5: lethargy, slurred speech, muscle weakness, nausea, and vomiting
      • Levels 1.5 to 2: above reactions plus ECG changes
      • Levels 2 to 2.5: ataxia, clonic movements, hyperreflexia, and seizures
      • Levels less than 2.5: complex multiorgan toxicity and significant risk of death
  • Drug-to-drug interactions
    • Haloperidol
    • Carbamazepine
    • Thiazide diuretic

Site of Action of the CNS Stimulants in the RAS

Site of Action of the CNS Stimulants in the RAS
Site of Action of the CNS Stimulants in the RAS

 

 

Central Nervous System Stimulants

  • Action
    • CNS stimulants act as cortical and RAS, possibly by increasing the release of catecholamines from presynaptic neurons; this leads to an increase in stimulation of the postsynaptic neurons
  • Indications
    • Treatment attention: deficit syndromes
    • Narcolepsy
  • Pharmacokinetics
    • Rapidly absorbed from the GI tract
    • Peak in 2 to 4 hours
    • Metabolized in the liver
    • Excreted in the urine
    • T½ 2 to 15 hours
  • Contraindications
    • Known allergy, marked anxiety, agitation, tension, severe fatigue, and glaucoma
  • Adverse effects
    • Nervousness, insomnia, dizziness, headache, blurred vision, anorexia, nausea, and weight loss
  • Drug-to-drug interactions
    • MAOIs
    • Guanethidine
    • Tricyclic antidepressants
    • Phenytoin

Use of Psychotherapeutic Agents Across the Lifespan

Use of Psychotherapeutic Agents Across the Lifespan
Use of Psychotherapeutic Agents Across the Lifespan

Prototype Typical Antipsychotic Drugs

Prototype Typical Antipsychotic Drugs
Prototype Typical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs
Prototype Atypical Antipsychotic Drugs

Prototype Central Nervous System Stimulants

Prototype Central Nervous System Stimulants
Prototype Central Nervous System Stimulants

Nursing Considerations for Antipsychotic/Neuroleptic Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antimanic Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Central Nervous System Stimulants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Antidepressant Agents

Antidepressant Agents

Affective Disorders vs Depression

  • Affective disorder
    • A person’s mood goes far beyond the normal “ups and downs”
  • Depression
    • Severe and long-lasting feelings of sadness beyond the precipitating event

Signs and Symptoms of Depression

  • Low energy level
  • Sleep disturbances
  • Lack of appetite
  • Limited libido
  • Inability to perform activities of daily living
  • Overwhelming feelings of sadness, despair, hopelessness, and disorganization

Biogenic Amine Theory of Depression

  • Depression results from a deficiency of norepinephrine (NE), dopamine, or serotonin (5HT)
    • Monoamine oxidase (MAO) may break them down to be recycled or restored in the neuron
    • Rapid fire of neurons may lead to their depletion
    • The number or sensitivity of postsynaptic receptors may increase, depleting neurotransmitter levels

Actions of Antidepressant Therapy

  • Inhibits the effects of MAO, leading to increased NE or 5HT in the synaptic cleft
  • Blocks reuptake by the releasing nerve, leading to increased neurotransmitter levels in the synaptic cleft
  • Regulates receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in the synaptic cleft

Classifications of Antidepressants

  • Tricyclic antidepressants (TCAs)
  • MAO inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)

Sites of Action for Selected Antidepressants

Sites of Action for Selected Antidepressants
Sites of Action for Selected Antidepressants

 

 

Tricyclic Antidepressants

  • Actions
    • Reduce the reuptake of 5HT and NE into nerves
  • Use
    • All TCAs are similar
    • Choice depends on individual response to the drug and tolerance of adverse effects
  • Indications
    • Relief of symptoms of depression
    • Used for patients with sleep disorders
    • Treatment of enuresis
    • Chronic pain
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 2 to 4 hours
    • Bound to plasma proteins and lipid soluble
    • Metabolized in the liver and excreted in the urine
    • T½ 8 to 46 hours
  • Contraindications
    • Known allergy, recent MI, myelography, pregnancy, and lactation
  • Cautions
    • CV disease, angle closure glaucoma, urinary retention, and manic depression
  • Adverse reactions
    • Sedation, sleep disturbances, fatigue, hallucinations, ataxia, dry mouth, constipation, nausea, and vomiting
  • Drug-to-drug interactions
    • MAOIs, cimetidine, fluoxetine, ranitidine, and oral anticoagulants

Monoamine Oxidase Inhibitors (MAOIs)

  • Isocarboxazid (Marplan)
    • Used for patients who do not respond to or cannot take newer, safer antidepressants
  • Phenelzine (Nardil)
    • Used for some patients who do not respond to newer, safer antidepressants
  • Tranylcypromine (Parnate)
    • Used for adult outpatients with reactive depression
  • Action
    • Irreversibly inhibit MAOs, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft
  • Indication
    • Treatment of patients with depression who are unresponsive to or unable to take other antidepression agents
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 2 to 3 hours
    • Metabolized in the liver and excreted in the urine
    • Cross placenta and enter breast milk
  • Contraindications
    • Known allergy, pheochromocytoma, CV disease, headaches, and renal or hepatic impairment
  • Adverse reactions
    • Dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation, liver toxicity, nausea, vomiting, diarrhea or constipation, anorexia, weight gain, dry mouth, and abdominal pain
  • Drug-to-drug interactions
    • Other antidepressants: hypertensive crisis and coma
    • Methyldopa: sympathomimetic effects increase
    • Insulin or oral antidiabetic agents: additive hypoglycemia
  • Food interactions
    • Tyramine or pressor amines: increase blood pressure

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • The newest group of antidepressant drugs
  • Specifically block the reuptake of 5HT, with little to no known effect on NE
  • Do not have the many adverse effects associated with TCAs and MAOIs
  • Action
    • Inhibit CNS neuronal reuptake of serotonin with little effect on norepinephrine and little affinity for cholinergic, histaminic, or alpha-adrenergic sites
  • Indications
    • Depression, OCD, panic attacks, bulimia, PMDD, posttraumatic stress disorders, social phobias, and social anxiety disorders
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Metabolized in the liver
    • Associated with congenital abnormalities
  • Contraindications
    • Known allergy, pregnancy, lactation, and impaired renal or hepatic function
  • Adverse reactions
    • Headache, drowsiness, dizziness, insomnia, anxiety, tremor, and agitation
  • Drug-to-drug interactions
    • MAOIs
    • TCAs increase therapeutic and toxic effect

Miscellaneous Antidepressants

  • Bupropion (Wellbutrin, Zyban)
  • Mirtazapine (Remeron)
  • Nefazodone (Serzone)
  • Trazodone (Desyrel)
  • Venlafaxine (Effexor)

Use of Antidepressant Agents Across the Lifespan

Use of Antidepressant Agents Across the Lifespan
Use of Antidepressant Agents Across the Lifespan

Prototype Tricyclic Agent

Prototype Tricyclic Agent
Prototype Tricyclic Agent

Prototype MAOIs Agent

Prototype MAOIs Agent
Prototype MAOIs Agent

Prototype SSRI Agent

Prototype SSRI Agent
Prototype SSRI Agent

Nursing Considerations for Tricyclic Antidepressant Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for MAOI Antidepressant Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for SSRI Antidepressant Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Anxiolytic and Hypnotic Agents

Anxiolytic and Hypnotic Agents

Types of Anxiolytic and Hypnotic Agents

  • Anxiolytics
    • Prevent feelings of tension or fear
  • Sedatives
    • Calm and make patients unaware of the environment
  • Hypnotics
    • Cause sleep
  • Minor tranquilizers
    • Produce a state of tranquility in anxious patients

States Affected by Anxiolytic and Hypnotic Drugs

  • Anxiety
  • –Feeling of tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus
  • Sedation
  • –Loss of awareness and reaction to environmental stimuli
  • Hypnosis
  • –Extreme sedation resulting in further CNS depression and sleep

Sites of Action of Benzodiazepines and Barbiturates

Sites of Action of Benzodiazepines and Barbiturates
Sites of Action of Benzodiazepines and Barbiturates

 

 

Benzodiazepines—Actions

  • Act in the limbic system and the RAS
  • Make GABA more effective
  • Cause interference with neurons firing
  • Lower doses cause anxiolytic effects
  • Higher doses cause sedation and hypnosis

Benzodiazepines—Indications

  • Anxiety disorders
  • Alcohol withdrawal
  • Hyperexcitability and agitation
  • Preoperative relief of anxiety and tension

Benzodiazepines—Pharmacokinetics

  • Well absorbed from the GI tract
  • Peak levels achieved in 30 minutes to 2 hours
  • Lipid soluble and well distributed throughout the body
  • Cross placenta
  • Enter breast milk
  • Metabolized in the liver
  • Excretion is primarily in the urine

Benzodiazepines—Contraindications & Cautions

  • Allergy to benzodiazepines
  • Psychosis
  • Acute narrow angle glaucoma
  • Shock
  • Coma
  • Acute alcohol intoxication
  • Pregnancy

Benzodiazepines—Adverse Effects

  • Sedation
  • Drowsiness
  • Depression
  • Lethargy
  • Blurred vision
  • Confusion
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Hypotension
  • Urinary retention

Benzodiazepines—Drug-to-Drug Interactions

  • Increase CNS depression when taken with alcohol
  • Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
  • Decrease in effect if given with theophylline or ranitidine

Barbiturates

  • Act as a general CNS depressant
  • Inhibit neuronal impulse conduction in the ascending RAS
  • Depress the cerebral cortex
  • Alter cerebellar function
  • Depress motor output

Barbiturates—Actions

  • CNS depressant
  • Inhibit neuronal impulse conduction in the ascending RAS
  • Depress cerebral cortex
  • Depress motor output
  • Cause sedation, hypnosis, anesthesia, and coma

Barbiturates—Indications

  • Relief of the signs and symptoms of anxiety
  • Sedation
  • Insomnia
  • Preanesthesia
  • Seizures

Barbiturates—Pharmacokinetics

  • Well absorbed
  • Reach peak in 20 to 60 minutes
  • Metabolized in the liver
  • Excreted in the urine

Barbiturates—Contraindications & Cautions

  • Allergy to any barbiturate
  • Previous history of addiction to sedative–hypnotic drugs
  • Latent or manifest porphyria
  • Marked hepatic impairment or nephritis
  • Respiratory distress or severe respiratory dysfunction
  • Pregnancy

Barbiturates—Adverse Reactions

  • CNS depression
  • Physical dependency
  • Drowsiness
  • Somnolence
  • Lethargy
  • Ataxia
  • Vertigo
  • Nausea
  • Vomiting
  • Constipation

Barbiturates—Drug-to-Drug Interactions

  • Increase CNS depression when given with alcohol, antihistamines, and other tranquilizers
  • Alter response to phenytoin
  • MAOs increase serum levels and effect
  • Decrease effectiveness of the following drugs:  anticoagulants, digoxin, tricyclic antidepressants, corticosteroids, and oral contraceptives

Other Anxiolytic and Hypnotic Drugs

  • Paraldehyde (Paral): sedates patients with delirium tremens or psychiatric conditions characterized by extreme excitement
  • Meprobamate (Miltown): manages acute anxiety for up to 4 months
  • Chloral hydrate (Aquachloral): produces nocturnal sedation or preoperative sedation
  • Glutethimide (generic), zaleplon (Sonata), and zolpidem (Ambien): short-term treatment of insomnia
  • Antihistamines (promethazine [Phenergan], diphenhydramine [Benadryl]: preoperative medications, and postoperatively to decrease the need for narcotics
  • Buspirone (BuSpar): reduces the signs and symptoms of anxiety without severe CNS and adverse effects

Use of Anxiolytic and Hypnotic Agents Across the Lifespan

Use of Anxiolytic and Hypnotic Agents Across the Lifespan
Use of Anxiolytic and Hypnotic Agents Across the Lifespan

Prototype Benzodiazepines Agent

Prototype Benzodiazepines Agent
Prototype Benzodiazepines Agent

Prototype Barbiturates Agent

Prototype Barbiturates Agent
Prototype Barbiturates Agent

Nursing Considerations for Benzodiazepines

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Barbiturates

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
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Introduction to Nerves and the Nervous Systems

Introduction to Nerves and the Nervous System

Role of the Nervous System

  • Controls the functions of the human body
  • Analyzes incoming stimuli
  • Integrates internal and external responses

Makeup of the Nervous System

  • Central nervous system (CNS)
    • Composed of the brain and spinal cord
  • Peripheral nervous system (PNS)
    • Sensory receptors bring information into the CNS
    • Motor nerves carry information away from the CNS
  • Autonomic nervous system (ANS)
    • Uses components of the CNS and PNS to regulate automatic or unconscious responses to stimuli

Functions of the Cells That Make Up the Nervous System

  • Allow movement
  • Allow realization of various sensations
  • Provide response to internal and external stimuli
  • Stimulate learning, thinking, and emotions

Neuron

Neuron
Neuron

 

 

Types of Axons

  • Afferent fibers
    • Nerve axons that run from peripheral receptors into the CNS
  • Efferent fibers
    • Nerve axons that carry nerve impulses from the CNS to the periphery to stimulate muscles or glands

Action Potential

Action Potential
Action Potential

 

 

Electrolytes Involved in Nerve Cell Action

  • Sodium
  • Potassium
  • Calcium

Movement of Electrolytes With Action

  • Rest/repolarization
    • Membrane is impermeable to sodium
    • Membrane is permeable to potassium
  • Action/depolarization
    • Sodium goes into the cell
    • Potassium leaves the cell

Formation of Myelin Sheath

Formation of Myelin Sheath
Formation of Myelin Sheath

 

 

Nerve Synapse

  • Presynaptic nerve
  • Synaptic cleft
  • Postsynaptic effector cell

Neurotransmitters

  • Acetylcholine
    • Communicates between nerves and muscles
  • Norepinephrine and epinephrine
    • Catecholamines released by nerves in the sympathetic branch of the ANS
  • Dopamine
    • Involved in the coordination of impulses and responses
  • Gamma-aminobutyric acid (GABA)
    • Inhibits nerve activity and is important in preventing overexcitability or stimulation such as seizure activity
  • Serotonin
    • Important in arousal and sleep and in preventing depression and promoting motivation

Central Nervous System

  • Made up of brain and spinal cord
  • Structures are covered by meninges
  • Blood–brain barrier
  • Blood supply to the brain

Anatomy of the Brain

Anatomy of the Brain
Anatomy of the Brain

 

 

Hindbrain

  • Runs from the top of the spinal cord into the midbrain
  • Most primitive part of the brain: contains the brain stem
  • Controls basic vital functions:
    • Breathing
    • Blood pressure
    • Swallowing
    • RAS

Midbrain

  • Contains the thalamus, the hypothalamus, and the limbic system
    • The thalamus sends direct information into the cerebrum to transfer sensations
    • The hypothalamus acts as the major sensor of activity in the body
      • Temperature regulation
      • Water balance
      • Appetite
      • Endocrine function

Limbic System

  • Contains high levels of the neurotransmitters:
    • Epinephrine
    • Norepinephrine
    • Serotonin
  • Controls expression of emotions

Forebrain

  • Made up of 2 cerebral hemispheres joined together by the corpus callosum
  • Receives and sends nerve impulses, coordinates speech and communication, and facilitates learning

Spinal Cord

  • Made up of 31 pairs of spinal nerves
  • Each spinal nerve has 2 components or roots
    • Sensory fiber (dorsal root)
      • Brings information into the CNS from the periphery
    • Motor fiber (ventral root)
      • Causes movement or reaction

Functions of Central Nervous System

  • Sensory functions
  • Motor functions
  • Intellectual and emotional functions

Intellectual and Emotional Function

  • Two hemispheres of the brain process information differently
  • Right side
    • Artistic
  • Left side
    • Analytical
  • When learning takes place, an actual change occurs in a neuron
  • Some degree of stress facilitates learning
  • Increased stress inhibits learning
  • The limbic system plays a role in learning
  • Emotions associated with memory and the present have an impact on stimulus response
Categories
Chemotherapeutic Agents Nursing Pharmacology

Vaccines and Sera

Vaccines and Sera

Biologicals—Actions

  • Stimulate the production of antibodies
  • Provide preformed antibodies to facilitate an immune reaction
  • React specifically with the toxins produced by an invading pathogen

Types of Immunity

  • Active immunity
    • The body recognizes a foreign protein and begins producing antibodies to react with it
  • Passive immunity
    • Occurs when preformed antibodies are injected into the system and react with a specific antigen

Immunization

  • Definition
    • The process of artificially stimulating active immunity
    • Exposes the body to weakened or less toxic proteins associated with specific disease-causing organisms
  • Goal
    • To cause an immune response without having the patient suffer the full course of a disease

Childhood Vaccinations

  • Diphtheria, pertussis, and tetanus
  • Haemophilus B
  • Hepatitis B and hepatitis A
  • Chickenpox
  • Polio
  • Measles, mumps, and rubella

Vaccines—Indications

  • Stimulate active immunity in people who are at risk
  • The vaccine needed depends on the exposure the person will have to pathogens
  • Vaccines are thought to provide lifelong immunity

Vaccines—Contraindications

  • In the presence of immune deficiency
  • During pregnancy
  • Known allergies to any of the components of the vaccine
  • Patients who receive immune globulin or who have received blood or blood products within the last 3 months
  • Caution with history of febrile convulsions or cerebral injury, conditions in which high fever would be dangerous, and during acute infection

Vaccines–Adverse Effects

  • Fever
  • Rash
  • Malaise
  • Chills
  • Fretfulness
  • Drowsiness
  • Anorexia
  • Vomiting
  • Irritability
  • Pain, redness, and swelling at the injection site

Site of Action of Vaccines, Immune Sera, and Antitoxins

Site of Action of Vaccines, Immune Sera, and Antitoxins
Site of Action of Vaccines, Immune Sera, and Antitoxins

Immune Sera

  • Definition
    • Sera that contain antibodies to specific bacteria or viruses
  • Types
    • Antitoxin and antivenom
      • Immune sera have antibodies to specific toxins that might be released by invading pathogens, or to venom from spider or snake bites

Immune Sera and Antitoxins—Indications

  • Provide passive immunity to a specific antigen or disease
  • Used as prophylaxis against specific disease after exposure
  • May lessen the severity of a disease

Immune Sera and Antitoxins

  • History of severe reaction to any immune sera
  • Use with caution:
    • Pregnancy
    • Coagulation defects
    • Previous exposure to the immune sera
    • Rash
    • Nausea
    • Vomiting
    • Chills
    • Fever
  • Allergic reaction
    • Chest tightness, decreased blood pressure, and difficulty breathing
  • Local reaction
    • Swelling, tenderness, pain, and muscle stiffness at the injection site

Biological Weapons

Biological Weapons
Biological Weapons

Use of Biologicals Across the Lifespan

Use of Biologicals Across the Lifespan
Use of Biologicals Across the Lifespan

Adult Immunization Schedule

Adult Immunization Schedule
Adult Immunization Schedule

Childhood Immunization Schedule

Childhood Immunization Schedule
Childhood Immunization Schedule

Prototype Vaccine

Prototype Vaccine
Prototype Vaccine

Prototype Immune Sera

Prototype Immune Sera
Prototype Immune Sera

Nursing Considerations for Vaccines

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Immune Sera and Antitoxins

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Immune Modulators

Immune Modulators

 

Sites of Actions of Immune Modulators

  • Immune modulators
    • Modify the actions of the immune system
  • Immune stimulants
    • Energize the immune system when it needs help fighting a specific pathogen
  • Immune suppressants
    • Block the normal effects of the immune system in organ transplantation and autoimmune disorders

Immune Stimulants

  • Interferons
    • Naturally released from human cells in response to viral invasion
  • Interleukins
    • Communicate between lymphocytes, stimulate cellular immunity, and inhibit tumor growth
  • T and B cell modulator (levamisole)
    • Restores immune function and activity

Interferon

  • Actions
    • Prevents virus particles from replicating inside other cells
    • Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
    • Inhibits tumor growth and replication
  • Pharmacokinetics
    • Absorbed well after subcutaneous or intramuscular injection
    • Broken down in the tissues
    • Excreted in the kidneys
    • May be teratogenic
  • Contraindications
    • Known allergy
    • Pregnancy and lactation
    • Use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, anorexia, nausea, headache, dizziness, and bone marrow depression
  • Drug-to-drug interactions

Interleukins

  • Definition
    • Chemicals produced by T cells to communicate between leukocytes
  • Types of preparations
    • Aldesleukin (Proleukin)
      • Human interleukin produced by recombinant DNA technology using Escherichia coli bacteria
    • Oprelvekin (Neumega)
      • A newer agent produced by DNA technology
  • Actions
    • Increase the number of natural killer cells and lymphocytes
    • Activate cellular immunity and inhibit tumor growth
  • Indications
    • Aldesleukin: specific renal carcinomas and possible treatment of AIDS and AIDS-related disorders
    • Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy
  • Pharmacokinetics
    • Rapidly distributed after injection
    • Cleared by the kidneys
    • Teratogenic
  • Contraindications
    • Known allergy, pregnancy, and lactation
    • Caution with renal, liver, or cardiovascular impairment
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, fatigue, fever, and respiratory difficulties

T and B Cell Modulators

  • Action/Indication
    • Levamisole stimulates B cells which in turn stimulate antibody formation, enhancing T cell activity
    • Used in the treatment of Duke’s stage C colon cancer
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peaks in 1.5 to 2 hours
    • Metabolized in the liver and excreted in the urine
    • T½ of 16 hours
  • Contraindications
    • Known allergy, pregnancy, and lactation
  • Adverse reactions
    • Headache, dizziness, ataxia, nausea, vomiting, and diarrhea
  • Drug-to-drug interactions
    • Disulfiram-type reaction
    • Increased phenytoin levels

Types of Immune Suppressants

  • T and B cell suppressors
  • An interleukin receptor antagonist
  • Monoclonal antibodies
    • Produced by a single clone of B cells that react with specific antigens

T and B Cell Suppressors

  • Azathioprine (Imuran): prevents rejection in renal hemotransplants; treats rheumatoid arthritis
  • Cyclosporine (Sandimmune): suppresses rejection in a variety of transplants; treats rheumatoid arthritis and psoriasis
  • Glatiramer acetate (Copaxone): reduces number of relapses in multiple sclerosis in adults
  • Mycophenolate mofetil (CellCept): prevents rejection after renal or heart transplant in adults
  • Sirolimus (Rapamune): prevents rejection after renal transplantation
  • Tacrolimus (Prograf): prevents rejection after liver transplantation
  • Action
    • Inhibit DNA synthesis
  • Contraindications
    • Known allergy, pregnancy, CNS disease, and hepatic disease
  • Drug-to-drug interactions

T and B Cell Suppressor Adverse Effects

  • Increased risk for infection and development of neoplasms
  • Hepatotoxicity
  • Renal toxicity and renal dysfunction
  • Pulmonary edema
  • Possible headache, tremors, and secondary infections such as acne, GI upset, diarrhea, and hypertension

Interleukin Receptor Antagonists

  • Actions
    • Used to treat rheumatoid arthritis
    • Block activity of interleukin-1
  • Pharmacokinetics
    • Given subcutaneously
    • Reach peak in 3 to 7 hours
    • Metabolized in the tissues
    • T½ of 4 to 6 hours
  • Contraindications
    • Known allergy, pregnancy, lactation, and renal impairment
  • Adverse reactions
    • Headache, sinusitis, nausea, and diarrhea
  • Drug-to-drug interaction
    • Etanercept may cause severe and even life- threatening infections

Monoclonal Antibodies

  • Action
    • Antibodies attach to specific receptors
  • Pharmacokinetics
    • Must be injected
  • Contraindications
    • Known allergy and fluid overload
  • Adverse reactions
    • Pulmonary edema, fluid retention, flu-like symptoms
  • Drug-to-drug interaction
    • Severe immune suppression can occur

Use of Immune Modulators Across the Lifespan

Use of Immune Modulators Across the Lifespan
Use of Immune Modulators Across the Lifespan

Prototype Immune Stimulants

Prototype Immune Stimulants
Prototype Immune Stimulants

Prototype Interleukins

Prototype Interleukins
Prototype Interleukins

Prototype T and B Cell Suppressors

Prototype T and B Cell Suppressors
Prototype T and B Cell Suppressors

Prototype Monoclonal

Prototype Monoclonal
Prototype Monoclonal

Nursing Considerations for Immune Stimulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Immune Suppressants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Immune System Nursing Pharmacology

Anti-inflammatory Agents

Anti-inflammatory Agents

Inflammatory Response

  • Protects the body from injury and pathogens
  • Uses chemical mediators to produce the reaction that helps destroy pathogens and promote healing

Anti-inflammatory Agents

  • Block or alter the chemical reactions associated with the inflammatory response

Types of Anti-inflammatory Agents

  • Corticosteroids: used systemically to block the inflammatory and immune systems
  • Antihistamines: block the release of histamine in the initiation of the inflammatory response

Salicylates

  • Can block the inflammatory response
  • Have antipyretic (fever-blocking) properties
  • Have analgesic (pain-blocking) properties

NSAIDs

  • Provide strong anti-inflammatory and analgesic effects
  • Sold over the counter, which may lead to abuse

Common Salicylates

  • Aspirin (Bayer,etc.): treats inflammatory conditions
  • Balsalazide (Colazal): new drug that treats ulcerative colitis
  • Choline magnesium trisalicylate (Trilisate): treats mild pain and fevers as well as arthritis
  • Choline salicylate (Arthropan): treats mild pain and fevers as well as arthritis
  • Mesalamine (Pentasa, etc.): treats inflammation of the large intestine
  • Olsalazine (Dipentum): converted to mesalamine in the colon; has the same direct anti-inflammatory effects
  • Salsalate (Argesic, etc.): treats pain, fever, and inflammation
  • Sodium thiosalicylate (Rexolate): treats episodes of acute gout and muscular pain as well as rheumatic fever

Salicylates

  • Action/indication
    • Inhibit synthesis of prostaglandin; used to treat mild to moderate pain and fever
  • Pharmacokinetics
    • Absorbed from the stomach, peak in 5 to 30 min., metabolized in the liver, and excreted in the urine
  • Contraindications
    • Known allergy, bleeding abnormalities, and impaired renal function
  • Drug-to-drug interactions
    • Interact with other drugs by interfering with absorption

Salicylates—Adverse Effects

  • GI irritation
    • Nausea, dyspepsia, and heartburn
  • Clotting system
    • Blood loss and bleeding abnormalities
  • Eighth cranial nerve stimulation
  • Salicylism
    • Ringing in the ears
    • Acidosis
    • Nausea, vomiting, and diarrhea
    • Mental confusion and lassitude

Types of NSAIDs

  • Propionic acids
    • Fenoprofen
    • Ibuprofen
  • Acetic acids
    • Diclofenac
    • Etodolac
  • Fenamates
    • Mefenamic acid
  • Cyclooxygenase-2 inhibitors
    • Celecoxib

NSAIDs Indications

  • Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis
  • Relief of mild to moderate pain
  • Treatment of primary dysmenorrhea
  • Fever reduction

Contraindications to NSAIDs

  • Presence of allergy to any NSAID or salicylate
  • Cardiovascular dysfunction or hypertension
  • Peptic ulcer or known GI bleeding
  • Pregnancy and lactation
  • Caution with renal or hepatic dysfunction

Other Anti-inflammatory Agents

  • Acetaminophen (Tylenol)
  • Gold compounds
  • Antiarthritic drugs

Acetaminophen

  • Action/indications
    • Acts directly on the thermoregulatory cells of the hypothalamus
    • Mechanism of action related to analgesic effects is not certain
    • Used to treat pain and fever
      • Treatment of pain and fever associated with a variety of conditions, including influenza
      • Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations
      • Relief of musculoskeletal pain associated with arthritis
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peaks in ½ to 2 hours
    • Metabolized in the liver
    • Excreted in the urine
    • T½ is about 2 hours
  • Contraindications
    • Known allergy
    • Use with caution in pregnancy and lactation
  • Adverse reactions
      • Headache, hemolytic anemia, renal dysfunction, skin rash, fever, and hepatotoxicity
    • Drug-to-drug interactions
      • Oral anticoagulants increase bleeding

Gold Compounds

  • Action
    • Absorbed by macrophages, which results in inhibition of phagocytosis
  • Indication
    • Tissue destruction is decreased
  • Pharmacokinetics
    • Absorption varies based on the site of administration
    • Widely distributed throughout the body
  • Contraindications
      • Known allergy
      • Diabetes, CHF, and renal or hepatic impairment
    • Adverse reactions
      • Stomatitis, glossitis, gingivitis, bone marrow depression, and dermatitis
    • Drug-to-drug interactions
      • Penicillamine, antimalarials, cytotoxic drugs, and immunosuppressive agents

Other Antiarthritis Drugs

  • Etanercept (Enbrel)
  • Leflunomide (Arava)
  • Penicillamine (Depen)
  • Hyaluronidase derivative (Synvisc)
  • Sodium hyaluronate (Hyalgan)
  • Anakinra (Kineret)

Use of Anti-inflammatory Agents Across the Lifespan

Use of Anti-inflammatory Agents Across the Lifespan
Use of Anti-inflammatory Agents Across the Lifespan

 

 

Prototype Salicylates

Prototype Salicylates
Prototype Salicylates

 

 

Prototype NSAIDs

Prototype NSAIDs
Prototype NSAIDs

 

 

Prototype Acetaminophen

Prototype Acetaminophen
Prototype Acetaminophen

 

 

Prototype Gold Compound

Prototype Gold Compound
Prototype Gold Compound

 

 

Nursing Considerations for Salicylates

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for NSAIDs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Immune System Nursing

Introduction to the Immune Response and Inflammation

Introduction to the Immune Response and Inflammation

Body’s Defenses

  • Barrier defenses
  • Cellular defenses
  • Inflammatory response
  • Immune response

Barrier Defenses

  • Skin
    • Protects the internal tissues and organs of the body
  • Mucous membrane
    • Lines the areas of the body that are exposed to external influences but do not have skin protection
  • Gastric acid
    • Secreted by the stomach in response to many stimuli
  • Major histocompatibility complex
    • Distinguishes between self-cells and foreign cells

Types of Cellular Defenses

  • Mononuclear phagocyte system (MPS)
    • Composed of:
      • Thymus gland
      • Lymphatic tissue
      • Leukocytes
      • Lymphocytes
      • Numerous chemical mediators

Types of White Blood Cells—Leukocytes—Produced by the Body

Types of White Blood Cells Leukocytes Produced by the Body
Types of White Blood Cells Leukocytes Produced by the Body

 

 

Types of Leukocytes

Types of Leukocytes
Types of Leukocytes

 

 

The Inflammatory Response Hageman Factor (Factor XII)

  • A chemical in the plasma activated by cell injury
  • Responsible for activating three systems in the body
    • The kinin system
    • The clotting cascade: starts blood clotting
    • The plasminogen system: starts the dissolution of blood clots

The Role of Bradykinin

  • Causes local vasodilation
  • Stimulates nerve endings to cause pain
  • Causes the release of arachidonic acid
  • This release of arachidonic acid causes the release of autocoids

Types of Autocoids Released

  • Prostaglandins
    • Some augment the inflammatory reaction and some block it
  • Leukotrienes
    • Some can cause vasodilation and increased capillary permeability and some can block the reactions
  • Thromboxanes
    • Cause local vasoconstriction and facilitate platelet aggregation and blood coagulation

Clinical Presentation

  • Calor (heat)
    • Caused by increased blood flow
  • Tumor (swelling)
    • Caused by fluid that leaks into the tissues
  • Rubor (redness)
    • Caused by the increase in blood flow due to vasodilation
  • Dolor (pain)
    • Caused by the activation of pain fibers

Inflammatory Response

Inflammatory Response
Inflammatory Response

 

 

Immune Response

  • Specific invasions stimulate specific responses through the immune system
    • Lymphocytes produced in the bone marrow can develop into T lymphocytes or B lymphocytes
    • Other identified lymphocytes include natural killer cells and lymphokine-activated killer cells
      • These cells are aggressive against neoplastic or cancer cells and promote rapid cellular death

Types of T Cells

  • Effector or cytotoxic T cells
  • Helper T cells
  • Suppressor T cells

Function of T Cells

  • Effector or cytotoxic T cells
    • Found throughout the body
    • Aggressive against non-self cells
    • Can directly destroy foreign cells or mark cell so other cells can destroy them
  • Helper T cells
    • Stimulate the activity of B cells and effector T cells
  • Suppressor T cells
    • Monitor the chemical activity in the body
    • Act to suppress B-cell and T-cell activity when the foreign antigen is under control

Cell-Mediated Response

Cell-Mediated Response
Cell-Mediated Response

 

 

The Role of the B Cell

  • Programmed to identify specific proteins or antigens
  • Involved in humoral immunity
  • Produces antibodies or immunoglobulins

Humoral Immune Response

Humoral Immune Response
Humoral Immune Response

 

 

Response to the Varicella Virus

Response to the Varicella Virus
Response to the Varicella Virus

 

 

Other Mediators in the Immune Response

  • •nterferons
    • Prevent viral replication and suppress malignant cell replication and tumor growth
  • Interleukins
    • Chemicals secreted by active leukocytes to influence other leukocytes
  • Tumor necrosis factor (TNF)
    • Chemical released by macrophages; inhibits tumor growth and can cause tumor regression

Conditions That Cause Problems Involving the Immune System

  • Neoplasm
  • Viral invasion
  • Autoimmune disease
  • Transplant rejection

Theories of Autoimmune Disease

  • Result of response to a cell that was invaded by a virus, leading to antibody production to similar cells
  • In a state of immunosuppression, the suppressor T cells do not suppress autoantibody production
  • There is a genetic predisposition to develop autoantibodies
Categories
Interpersonal/Caring Theories

Peplau’s Psychodynamic Nursing Theory

Peplau’s Psychodynamic Nursing Theory
Peplau’s Psychodynamic Nursing Theory

Hildegard Peplau is one of the first theorists since Nightingale to present a theory for nursing. She introduced her interpersonal concepts in 1952 and based them on available theories at the time: psychoanalytic theory, principles of social learning, and concepts of human motivation and personality development. Psychodynamic nursing is defined as understanding one’s own behavior to help others identify  felt difficulties and applying principles of human relations to problems arising during the experience.

Peplau views nursing as a maturing force that is realized as the personality develops through educational, therapeutic, and interpersonal process. Nurses enter into  a personal relationship with an individual when a felt need is present. This nurse-patient relationship evolves in four phases:

1. Orientation. During this phase, the patient seeks help and the nurse assists the patient to understand the problem and the extent of need for help.

2. Identification. During this phase, the patient assumes a posture of dependence, interdependence, or independence e in relation to the nurse (relatedness). The nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the patient’s situation.

3. Exploitaiton. In this phase, the patient derives full value from what the nurse offers through the relationship. The patient uses available services on the basis of self-interest and needs. Power shifts from the nurse to the patient.

4. Resolution. In this final phase, old needs and goals are put aside and new ones adopted. Once older needs are resolved, newer and more mature ones emerge.

During the nurse-patient relationship, nurses assumes many roles: stranger, teacher, resource person, surrogate, leader,  and counselor. Today Peplau’s model continues to be used by clinicians when working with individuals who have psychologic problems.

Reference:

Kozier, Barbare et. al Fundamentals of Nursing 5th edition

Addison Wesley Publishing Company Inc p53

Categories
Chemotherapeutic Agents Nursing Pharmacology

Antineoplastic Agents

Antineoplastic Agents

Neoplasm Cancer—Mechanisms of Growth

  • Anaplasia
    • Cancerous cells lose cellular differentiation and organization and are unable to function normally
  • Autonomy
    • Cancerous cells grow without the usual homeostatic restrictions that regulate cell growth and control
    • This allows the cells to form a tumor
  • Metastasis
    • Cancer cells travel from the place of origin to develop new tumors in other areas of the body
  • Angiogenesis
    • Abnormal cells release enzymes to generate blood vessels and supply oxygen and nutrients to the cells, generating growth
    • Cancerous cells rob the host cells of energy and nutrients and block normal lymph

The Body’s Immune System Response to Cancerous Cells

  • Can damage or destroy some neoplastic cells
  • T cells recognize the abnormal cells and destroy them
  • Antibodies form in response to parts of the abnormal cell protein
  • Interferons and tissue necrosis factor (TNF) play a role in the body’s attempt to eliminate the abnormal cells

Possible Causes of Cancer

  • Genetic predisposition
  • Viral infection
  • Constant irritation and cell turnover
  • Stress
  • Lifestyle factors
  • Environmental factors

Classifications of Tumors

  • Solid tumors
    • May originate in any body organ
    • Carcinomas (originate in epithelial cells)
    • Sarcomas (originate in the mesenchyma)
  • Hematologic malignancies
    • Leukemias and lymphomas that occur in the blood-forming organs

Mechanisms of Antineoplastic Drugs

  • Affect cell survival
  • Boost the immune system in its efforts to combat the abnormal cells

Goal of Cancer Treatment

  • To destroy cancer cells using the following methods:
    • Surgical removal
    • Stimulation of the immune system to destroy them
    • Radiation therapy to destroy them
    • Drug therapy to kill them during various phases of the cell cycle

Categories of Antineoplastic Agents

  • Alkylating agents
    • React chemically with portions of the RNA, DNA, or other cellular proteins
  • Antimetabolites
    • Have chemical structures similar to those of natural metabolites
  • Antineoplastic antibiotics
    • Not selective for bacterial cells only; toxic to human cells
  • Mitotic inhibitors
    • Drugs that kill cells as the process of mitosis begins
  • Hormones and hormone modulators
    • Used in cancers that are sensitive to estrogen stimulation
  • Cancer-cell–specific agents
    • Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST)

Sites of Action of Non-Cell-Cycle–Specific Antineoplastic Agents

Sites of Actions of Non-Cell-Cycle-Specific Antineoplastic Agents
Sites of Actions of Non-Cell-Cycle-Specific Antineoplastic Agents

 

 

Sites of Action of Cell-Cycle–Specific Antineoplastic Agents

Sites of Action Cell-Cycle-Specific Antineoplastic Agents
Sites of Action Cell-Cycle-Specific Antineoplastic Agents

Alkylating Agents

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Antimetabolites

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Antineoplastic Antibiotics

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Mitotic Inhibitors

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Hormones and Hormone Modulators

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Prototype Alkylating Agent

Prototype Alkylating Agent
Prototype Alkylating Agent

 

 

Prototype Antimetabolite Agent

Prototype Antimetabolite Agent
Prototype Antimetabolite Agent

 

 

Prototype Antineoplastic Antibiotics

Prototype Antineoplastic Antiboitics
Prototype Antineoplastic Antiboitics

 

 

Prototype Mitotic Inhibitors

Prototype Mitotic Inhibitors
Prototype Mitotic Inhibitors

 

Prototype Hormones and Hormone Modulators

Prototype Hormones and Hormone Modulators
Prototype Hormones and Hormone Modulators

 

 

Use of Antineoplastic Across the Lifespan

Use of Antineoplastic Across the Lifespan
Use of Antineoplastic Across the Lifespan

 

 

Nursing Considerations for Alkylating Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antimetabolites

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antineoplastic Antibiotics

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Mitotic Inhibitors

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Hormones and Hormone Modulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation