V Responsible for controlling the functions of

the human body, analyzing incoming stimuli

and integrating internal and external
responses.
V CNS Ȃ brain and spinal cord
V PNS Ȃ M
M  Mthat bring
information into CNS and 

Mthat
carry information away from the CNS to
facilitate response to stimuli.
V Structural unit of the nervous system.
V Human body contains about d  

neurons.
V ’bout 10 billion brain
V Chemical messengers
V Excitatory
× ’cetylcholine (’Ch) Ȃ controls activity in brain
associated with learning, attention and memory.
3 ’lzheimerǯs disease - ’Ch
× Norepinephrine (NE) and epinephrine Ȃ
cathecolamines fight or flight response
modulation of moods
 × opamine (’) Ȃ controls arousal level; gives
physical motivation; regulates thinking, emotion,
behavior and perception.
3 Parkinsonǯs disease - ’
V ½nhibitory
× Ôamma-aminobutyric acid (Ԓ ’) Ȃ regulation of
muscle tone and arousal; prevent overexcitability.
× Serotonin (5HT) Ȃ makes us happy; feel good
chemical; important in arousal and sleep.
V ’NX½
T½CS Ȃ drugs used to alter an
individuals responses to environment. They
prevent feelings of tension or fear.
V SE’T½ES Ȃ they can calm the patients and
make them unaware of their environment.
V HPN
T½CS Ȃ they can cause sleep.
V M½N
R TR’NQU½½ERS Ȃ they can produce
a state of tranquility in anxious patients.
V ’NX½ET Ȃ feeling of tension,
nervousness, apprehension or fear that
usually involves unpleasant reactions to
a stimulus.
V S/S:
× Sweating, fast HR, elevated P.
V Mild ’nxiety Ȃ serves as a stimulus or
motivator in some situations.
V SE’T½
N Ȃ loss of awareness and
reaction to environmental stimuli.
V HPN
S½S Ȃ extreme sedation results in
further CNS depression and sleep or
hypnosis.
× Hypnotics Ȃ used to help people fall asleep
by causing sedation.
V Most frequently used anxiolytic drugs,
prevent anxiety without causing much
associated sedation.
V ess likely to cause physical dependence.
V ½ndications:
× ’nxiety disorders, alcohol withdrawal,
hyperexcitability and agitation, pre-op
relief of anxiety and tension to aid in
balanced anesthesia.
V ’ntidote: Flumazenil
× Treat benzodiazepine overdose
× Reverse the sedation caused by
benzodiazepine
× Reverse sedation produced for
diagnostic tests.
V ere once the sedative/hypnotic drugs of
choice.
V Risk for addiction and dependence is
H½ÔHER.
V Ex.
× Phenobarbital
V ½ndications:
× Relief of the S/S of anxiety, sedation, insomnia,
pre-anesthesia and seizures.
V Most common classes of inducing
sleep agents.
V Ôiven pre and post op to reduce the
need for narcotics.
V Newer anti-anxiety agent
V Treatment for generalized anxiety
disorder.
V oes not cause sedation and muscle
relaxation.
V ’ffect Ȃ a term that is used to refer to
peopleǯs feelings in response to their
environment, whether + or -.
V epression Ȃ feelings of sadness are much
more severe and long lasting than the
suspected precipitating event and the mood
of the affected individual is much more
intense.
× NE, ’, or 5HT
V ’SSESS:
× enial Ȃ This canǯt be happening. This canǯt be
real.
× ’nger Ȃ hy me, why now, why Ôod?!
× argaining Ȃ ½f returned, ½ will give reward.
× epression Ȃ 2 weeks or more of symptoms =
clinical depression.
× ’cceptance Ȃ client acts according to situation. Pt.
prepares living will.
V Maslows:
×5
× 4 Ȃ decrease self-esteem = give T’SK
× 3 Ȃ pt. is withdrawn
× 2 Ȃ risk for self directed violence suicide
× 1 Ȃ eat (wt gain) or not eat (wt loss), sleep or
not sleep, hypoactive, decrease sex.
V SU½C½E CUES:
× ½ wonǯt be a problem any longerdz
× Remember me when ½ǯm gonedz
× This is my last daydz
× This is my wedding ring. Ôive it to my
sondz
3 Sudden change in mood.
V Pt. is suicidal, RN should
×  Ȃ direct question Ȃ ’re you
going to commit suicide?
× ½ - irregular interval of visit to pt
room
× E Ȃ early am and endorsement
period Ȃ time ptǯs commit suicide.
VS’
PERS
NS
V S Ȃ sex Ȃ male (more successful)/female
(hesitant)
V ’ Ȃ age Ȃ 15-24 y/o or above 45
V  Ȃ depression
V P Ȃ pt. with previous attempts will try again
V E Ȃ ET
H Ȃ (Ethanol) alcoholics
V R Ȃ irrational
V S Ȃ lacks social support
V
Ȃ organized plan
V N Ȃ no family
V S Ȃ sickness, terminal
V Suicide Triad:
× oss of spouse
× oss of job
× ’loneness

V est approach for suicide: direct

approach
V Nursing Mngt: Close surveillance
V Hospital area majority suicide happens at:
weekends, 1-3am Sunday
× eekend Ȃ less staff personnel
× Early am Ȃ everyone is asleep

V Ôive simple task. onǯ½ give complex task Ȃ

no jigsaw puzzle.
V ater plants
V ash dishes except sharp objects.
V Used today to counteract the effects of
neurotransmitter deficiencies in 3 ways:
× They may inhibit the effects of M’
, leading to
increased NE or 5HT.
× They block reuptake by releasing nerve, leading to
increased neurotransmitter levels.
× They regulate receptor sites and breakdown of
neurotransmitters, leading to an accumulation of
nuerotransmitter.
V Side effects:

ESC
UT
V Ȃ blurred vision
V E Ȃ ejaculation (delayed)
V  Ȃ dry mouth
V S Ȃ sedation
V C - constipation
V
Ȃ orthostatic hypotension
V U Ȃ urinary retention
V T Ȃ tachycardia
Tricyclic Antidepressant (TCA)
V Reduce the reuptake of 5HT and NE into
the nerves.
V ½ndication:
× Relief of symptoms of depression
V Has anticholinergic effects
× ESC
UT
 Tofranil
Clomipramine Ȃ
C
Asendin
Vu n amine Oxidase Inhibit r
(uAOI)
× Used for treatment-resistant depression
× Clients who failed to respond to TC’s or
who cannot tolerate SSR½s.
V M’
Ȃ kills 5HT
× ½ncreased M’
results to decreased 5HT
3 The more depressed the client becomes
V M’
½ Ȃ kills M’

× ½ncreased all neurotransmitters
3 Client prone to hypertensive crisis.

V Contraindication: Tyramine containing

foods
× ’ged cheese/meals
× ’vocado, banana, papaya
× ine, soy sauce, canned goods
P N’TE
N ½
M P’N
V Selective Serotonin Reuptake
½nhibitor (SSR½)
× First line of therapy for treating
depression
3 S Ȃ safest drug
3 S Ȃ side effects, low
3R
3 ½ Ȃ 1 to 4 weeks: effect
Prozac
Paxil
oloft
epressed ang magbarkadang si OORA,
[Norpramine] ELA [Elavil] at AOA
[’nafranil] ’t nagpunta ang tatlo sa
AVEOIA [’ventyl] Para makilahok sa
welga. Sila ay mga TOFn tchers
[Tofranil] ng kanilang mga unibersidad
at mga ASCEOERA [’scendin] ng
kani-kanilang mga angkan.
† Iu
RISOO [½mprin] ionisio and Madeja!
Sunugin SIOA KUAO! [Sinequan] VIVA
[ivactyl] Nursing Students! † ’ng
sinisigaw ng mga magkakabarkada at
nakasulat sa kanilang rally banner.

umating SI LEX [Celexa] ’ng pinaka

FAVERITE [Faverine] na newscaster sa
pinas.
Nora, ’na, Ela : † Mga
RO [Prozac]
Retake kami! i namin LUV [uvox] ang
mga
AXIL [Paxil] na oard examiners na
yan! Mabuti pang mag ZOLO [oloft]
Nalang kami at pupunta sa

AOAuA[Parnate, Nardil, Marplan] at
doon nalang kami mag nurse! ’ng sagot
ng mga magkakabarkada.
From N
RPR’M½NE up to
½’CT = TC’s
From CEEX’ up to 

FT =
SSR½
Parnate, Nardil and Marplan are
M’
½
V Mental isorders Ȃ now thought to
be caused by some inherent
dysfunction within the brain that
leads to abnormal thought
processes and responses.
V SM-½-TR Ȃ used as diagnosis of
mental disorder.
V Schiz phrenia Ȃ ½ncreased ’
× Characteristics:
3 Hallucinations
3 Paranoia
3 elusions
3 Speech abnormalities
3 ’ffective problems
V uania Ȃ bipolar illness (manic-
depressive illness)
× Characterized by periods of
extreme overactivity and
excitement
× Extreme depression followed by
hyperactivity and excitement.
V Oarc lepsy Ȃ characterized by daytime
sleepiness and sudden periods of loss of
wakefullness.
V Attenti n-eficit Hyperactive is rder
(AH) Ȃ characterized by inability to
concentrate on one activity for longer than a
few minutes and a state of hyperkinesis.
× Usually diagnosed in school-aged children but can
occur in adults.
V lock dopamine receptors
V Used to treat disorders that involve
thought processes.
V Neuroleptics/Major Tranquilizers
V Typical Ȃ dopamine receptor
blockers that cause several adverse
affects associated with dopamine
blockade including hypotension,
anticholinergic effects, EPS.
V ’typical Ȃ block both dopamine
receptors and serotonin receptors
× This dual action may help alleviate some of
the unpleasant neurological effects and
depression associated with the typical
antipsychotics.
V ½ndication: Schizophrenia and for
manifestations of other psychotic
disorders.
V yst nia Ȃ spasms of the tongue, neck,
back and legs. Spasms may cause
unnatural positioning of the neck,
abnormal eye movements, excessive
salivation

V 
C: Cogentin, enadryl

V ’kathisia Ȃ continuous restlessness,
inability to sit still, constant moving,
foot tapping, hand movements may
be seen.
V 
C: Propanolol ½nderal (beta-
blocker)
V Pseudoparkinsonism Ȃ muscle
tremors, cogwheel rigidity, drooling,
shuffling gait, slow movements

V 
C: Cogentin, enadryl

V Tardive dyskinesia Ȃ abnormal
muscle movements such as lip
smacking, tongue darting, chewing
movements, slow and aimless arms
and leg movements
 Akathisia

yst nia

seud parkins nism Tardive dyskinesia
V Phenothiazines Ȃ urine (pink to
reddish brown)
V Clozapine Ȃ can cause
agranulocytosis
V Haloperidol Ȃ potent antipsychotic
associated with severe EPS
V Risperidone
V Common Effects
× izziness, drowsiness and fainting
× Sensitivity to light
× Constipation
V Mania Ȃ opposite of depression
×
ccurs in individuals with bipolar
disorder
× Period of depression followed by a
period of mania.
× Thought to be due to overstimulation
of neurons.
V L Ȃ level (0.6 to 1.2 mEq/)
V I Ȃ instruction (avoid diuretics)
V T Ȃ tremors (
C: ½nderal)
V H Ȃ H2
(3, 3gms of Na in the diet)
V I Ȃ increased thirst, increased
urination
V U Ȃ uudz Ȃ diarrhea Ȃ sign of toxicity
V u Ȃ metallic taste (mouth dryness)
V Used clinically to treat both ’H
and Narcolepsy
V These drugs calm hyperkinetic
children and help them focus on one
activity for a longer period.
V Methylphenidate (Ritalin) Ȃ very
commonly used drug for the treatment
of ’H and other behavioral
syndromes associated with
hyperactivity, as well as narcolepsy.
× Should be given before 6PM to reduce
insomnia.
V Epilepsy Ȃ the most prevalent of
the neurological disorders.
× Sudden discharge of excessive
electrical energy from nerve cells
located within the brain, which
leads to seizure.
V Ôeneralized seizures Ȃ usually
experience a loss of consciousness
resulting from this massive electrical
activity throughout the brain.
V Types:
× Tonic-clonic seizures Ȃ grandmal seizures
3 ½nvolve dramatic tonic-clonic muscle
contractions, 
C and a rec0very period
characterized by confusion and exhaustion
V ’bsence seizures Ȃ petit mal seizures
× ½nvolve abrupt, brief (3 to 5 sec) periods of

C
×
ccur commonly in children and frequently
dissappear at puberty.
V Myoclonic seizures Ȃ involve short,
sporadic periods of muscle contractions
that last for several minutes
× Rare and often secondary seizures.
V Febrile seizures Ȃ r/t very high
fevers and usually involve
convulsions
× Frequently occur in children
× ’ state in which seizures rapidly
recur again and again.
V Partial seizure Ȃ focal seizures
×
ne area of the brain and do not
spread throughout the entire organ.
V Classification
× Simple partial seizures Ȃ occur in a
single area of the brain and may
involve in a single muscle movement
or sensory alteration
V Complex partial seizures Ȃ involve
complex sensory changes such as
hallucinations, mental distortion,
changes in personality, 
C and loss of
social inhibitions; motor changes Ȃ
involuntary urination, chewing motions,
diarrhea.
V Hydantoins Ȃ stabilize nerve
membranes and limit the spread of
excitability from the initiating focus.
× Phenytoin (ilantin) Ȃ T: 10-20mcg/m.
× Ethotoin Ȃ T: 15-50mcg/m
× Fosphenytoin
× Mephenytoin
V arbiturates and arbiturate-like rugs
× Phenobarbital Ȃ T: 15-40 mcg/m
× Primidone Ȃ 5-12 mcg/m
× Mephobarbital
V enzodiazepines
× iazepam
× Clonazepam
V Stabilize nerve membranes throughout
the CNS to decrease the excitability and
hyperexcitability to stimulation.
V ½ndicated for tonic-clonic seizures and
status epilepticus, for prevention of
seizures that occur after neurosurgery
and for adjunctive therapy for other
seizure disorders or sedation and muscle
relaxation.
V Succinimides Ȃ most frequently used to
treat these seizures are different from
the drugs used to treat or prevent tonic-
clonic seizures.
× Eth suximide Ȃ T: 40-100 mcg/m
× Methsuximide
× Phensuximide
V alpoic acid (epakene) Ȃ reduces
abnormal electric activity in the
brain and may also increase Ԓ ’
activity at inhibitory receptors
× 
C for Myoclonic seizures
V ’cetazolamide (iamox) Ȃ a sulfonamide drug
that is especially effective for treatment of
absence seizures in children.
× ’lso used to treat open-angle and secondary
glaucoma

V onisamide (onegran) Ȃ newer agent that

inhibits voltage-sensitive sodium and calcium
channels, thus stabilizing nerve cell membranes
and modulating calcium-dependent presynaptic
release of excitatory neurotransmitters.
V Carbamazepine (Tegretol) Ȃ 
C for
partial seizure
V Clorazepate (Tranxene) Ȃ indicated
for anxiety and alcohol withdrawal,
is alos used as adjunctive therapy for
partial seizures
V Felbamate
V Ôabapentin
V amotrigine
V evetiracetam
V
xcarbazepine
V Tiagabine
V Topiramate
V Parkinsonǯs isease
× Characteristics:
3 ack of coordination
3 Rhythmic tremors
3 radykinesia
3 Shuffling gait
3 rooling, slow and slurred speech
3 Mask-like depression
V Causes of egeneration
× iral infection
× lows to the head
× rain infection
× ’therosclerosis
× Exposure to certain drugs and
environmental factors.
V Substantia Nigra Ȃ a dopamine-
rich area, nerve cell bodies begin
to degenerate
× Results in a reduction of the
number of impulses sent to the
corpus striatum in the basal
ganglia
V There is no treatment that arrests the
neuron degeneration of the P and the
eventual decline in patient function.

V Surgical procedures involving the basal

ganglia have been tried with varying
success at prolonging the degeneration
caused by this disease.
V ’imed at restoring the balance
between the declining levels of
dopamine, which has an inhibitory
effect on the neurons in the basal
ganglia and the now-dominant
cholinergic neurons, which are
excitatory.
V rugs that oppose the effects of
acethylcholine at receptor sites
in the substantia nigra and the
corpus striatum, thus helping
restore chemical balance in the
area.
V enzotropine (Cogentin) Ȃ used to treat
parkinsonism and parkinson-like
symptoms that occur as a result of drug
effects of phenothiazines.
V iperiden (’kineton)
V iphenhydramine ( enadryl)
V Procyclidine (Kemadrin)
V Trihexyphenidyl (’rtane)
V ½ndications: treatment of
parkinsonism and for the relief of
symptoms of extrapyramidal
disorders
V rug that increase the effects of
dopamine at receptor sites, have
been proven to be even more
effective than anticholinergics in
the treatment of parkinsonism.
V evodopa Ȃ mainstay treatment of
parkinsonism
× Carbidopa
V ’mantadine
V romocriptine
V Pergolide
V Pramipexole
V Ropinirole
C’P’ ES
’ C Ȃ ’nticholinergic
PES Ȃ opaminergic
V Cogentin
V Artane
V
arlodel
V Akineton
V ëenadryl
V Levodopa
V Eldepryl
V Symmetrel
V Posture, balance and movement are the
result of a constantly fluctuating
sequence of muscle contraction and
relaxation.

V The nerves that regulate these actions

are the M
 
 M
V Muscle Spasm
×
ften result from injury to the musculo-skeletal
system.
3
verstretching a muscle
3 renching a joint
3 Tearing a tendon or ligament
× These injuries can cause violent and painful
involuntary muscle contraction.
V Muscle Spasticity
× The result of damage to
neurons within the CNS rather
than injury to peripheral
structures.
V ork in the CNS to interfere with the
reflexes that are causing the muscle
spasm.
V ecause these drugs lyse or destroy
spasm, they are often referred to as
spasmolytics.
V They work in the upper levels of CNS, so
possible depression must be anticipated
with their use.
V aclofen (0

M) Ȃ used for the tx of muscle
spasticity associated with neuromuscular
diseases such as MS, muscle rigidity and
spinal cord injuries.
V Carisoprodol (2) Ȃ indicated for the relief
of discomfort associated with
musculoskeletal pain.
V Chlorphenesin (u
)
V Chlorzoxazone (@  
)
V Metaxalone (2

) Ȃ recommended as
adjunct for the relief of discomfort associate
with acute, painful musculoskeletal
conditions.
V Metacarbamol (
) Ȃ to alleviate s/s of
tetanus.
V
rphenadrine (ë 


) Ȃ available
for the relief of acute painful musculoskeletal
conditions; relief of quinidine-induced leg
cramps.
V Tizanidine (º 
) Ȃ approved for
the acute and intermittent
management of increased muscle
tone associated with spasticity.
V iazepam (^
) Ȃ effective
centrally acting skeletal muscle
relaxant.
VRest of the affected
muscle
VHeat applications
VPhysical therapy
V’nti-inflammatory agents
V The primary indication is the
relief of discomfort associated
with acute, painful
musculoskeletal conditions as
adjunct to rest, physical therapy
and other measures.
V antrolene (antrium)
× ’vailable for use in treating (general)
spasticity that directly affects
peripheral muscle contraction.
× Not used for the treatment of muscle
spasms associated with
musculoskeletal injury or rheumatic
disorders.
V ½ndicated for the control of
spasticity resulting from upper
motor neuron disorders.
V ½ndicated for the prevention of
malignant hyperthermia, a state of
intense muscle contraction and
resulting hyperpyrexia.
V otulinim toxin type (Myobloc)
× ’ newer direct acting skeletal
muscle relaxant that is approved
for the reduction of the severity of
abnormal head position and neck
pain associated with cervical
dystonia.
V ’ sensory and emotional experience
associated with actual or potential
tissue damage.
V Two major types of drugs
× Narcotics Ȃ pain
× ’nti-migraine drugs Ȃ migraine
headaches
V rugs that react with the opioid
receptors throughout the body
to cause analgesia, sedation or
euphoria.
V Classified as controlled
substance.
V Ex: Morphine
V They are used as antitussives and as adjuncts
to general anesthesia to produce rapid
analgesia, sedation and a sense of well being.
V ½ndications: relief of severe acute or chronic
pain; preoperative medication; analgesia
during anesthesia.
V ½ administration is the most reliable way to
achieve therapeutic levels of narcotics.
V Common Effects:
× Constipation
× izziness, drowsiness and visual
changes
× Nausea and loss of appetite
V Stimulate certain opioid receptors but block
other such receptors.
V Example:
× Nalbuphine (O
)
V 3 Functions:
× Relief of moderate to severe pain
× ’djuncts to general anesthesia
× Relief of pain during labor and delivery
V rugs that bind strongly to opioid receptors, but
they do not activate the receptors.
V Useful in blocking unwanted adverse effects
associated with narcotics, such as respiratory
depression
V Ex:
× Naloxone (O ) Ȃ used to diagnose narcotic
overdose
× Naltrexone Ȃ used as part of comprehensive program
to treat narcotic and/or alcoholic dependence.
V Migraine Headache
× Used to describe several different syndromes, all
of which include severe, throbbing headaches on
one side of the head.

V Cluster Headaches
× Usually begin during sleep and involve sharp,
steady eye pain that last 15 to 90 minutes with
sweating, flushing, tearing and nasal congestion.
V Tension Headaches
× Usually occur at times of stress, feel
like a dull band of pain around the
entire head and last from 30 minutes
to 1 week
× ’ccompanied by anorexia, fatigue,
mild intolerance to light and sound.
V 2 types:
× Common migraines Ȃ occur without an aura,
cause severe, unilateral, pulsating pain that is
frequently accompanied by n/v and sensitivity to
light and sound.
3 ’ggravated by physical activities

× Classic migraines Ȃ usually preceded by an aura,

or a sensation involving sensory or motor
disturbances
V Cause constriction of cranial blood
vessels and decrease the pulsation of
cranial arteries.
V Ex:
× Ergotamine Ȃ mainstay of migraine
headache before the triptans.
V ½ndicated for the prevention or abortion
of migraine 0r vascular headaches.
V New class of drugs that cause
cranial vascular constriction and
relief of migraine headache pain.
V Ex:
× Sumatriptan (½

)
V rugs that are used to cause complete or
partial loss of sensation.
V Ôeneral ’nesthetics
× ’re CNS depressants used to produce loss of pain
sensation and consciousness.
V ocal ’nesthetics
× rugs used to cause loss of pain sensation and
feeling in a designated area of the body without
the systemic effects associated with severe CNS
depression.
V hen administering general
anesthetics, several different drugs are
combined to achieve the following
goals:
× ’nalgesia or loss of pain perception
× Unconsciousness or loss of awareness of
oneǯs surroundings
× ’mnesia or inability to recall what took
place
V lock the bodyǯs reflexes. lockage of
autonomic reflexes prevents the response of
involuntary reflexes to injury of the body that
might compromise a patientǯs cardiac,
respiratory, gastrointestinal and immune
status.
V lockage of muscle reflexes prevents jerking
movements that might interfere with the
success of surgical procedure.
V CNS factors: presence of any underlying
neurological disease that presents a risk for
abnormal reaction to the CNS-depressing and
muscle relaxing effects of these drugs.
V Cardiovascular factors: presence of underlying
vascular disease, coronary artery disease, or
hypotension which put patients at risk for severe
reactions to anesthesia including hypotension and
shock, arrhythmias and ischemia
V Respiratory factors: presence of obstructive
pulmonary disease which can complicate the
delivery of gas anesthesia as well as the intubation
and mechanical ventilation that must be used in
most cases of general anesthesia.
V Renal and hepatic function: conditions that interfere
with the metabolism and excretion of anesthetics
and could result in prolonged anesthesia and the
need for continued support during recovery.
V The use of a combination of drugs, each with
specific effect, to achieve analgesia, muscle
relaxation, unconsciousness and amnesia,
rather than the use of single drug.
V alanced anesthesia commonly involves the
following agents:
× Preoperative medications Ȃ w/c may include the
use of anticholinergics that decrease secretions to
facilitate intubation and prevent bradycardia
associated with neural depression.
× Sedative/hypnotics Ȃ to relax the patient,
facilitate amnesia and decrease sympathetic
stimulation
× ’ntiemetics Ȃ to decrease the nausea and
vomiting associated with Ô½ depression
× ’ntihistamines Ȃ to decrease the chance of
allergic reaction and to help dry up
secretions.
× Narcotics Ȃ to aid analgesia and sedation.
V ’nesthesia is delivered by a physician or
nurse anesthetist trained in the delivery of
these potent drugs with equipment for
intubation, mechanical ventilation and full
life support.
V uring the delivery of anesthesia, the
patient can go through predictable stages,
referred to as the depth of anesthesia.
V Stages:
× Stage 1: ’nalgesia Stage Ȃ refers to the loss
of pain sensation, with the patient still
conscious and able to communicate
× Stage 2: Excitement Stage Ȃ a period of
excitement and often combative behavior,
with many signs of sympathetic
stimulation.
V 2ta s:
× 2ta 3: 2 r ical A st sia Ȃ i v lv s
r laxati f sk l tal scl s, r t r f r lar
r s irati s a r r ssiv l ss f y r fl x s
a
il ilati . 2 r ry ca saf ly

rf r  i 2ta  3.
× 2ta  :  llary aralysis Ȃ vry 
2

rssi it l ss f rs
irat ry a 
vas t r ctr sti li, i ic at ca
cc r ra
ily.
V ½nduction Ȃ the period from the beginning of
anesthesia until stage 3 or surgical anesthesia
is reached.
× The danger period for many patients during
induction is stage 2 because of the systemic
stimulation that occurs.
× Many times a rapid acting anesthetic is used to
move quickly through this phase and into stage 3.
V Maintenance Ȃ the period from stage 3
until the surgical procedure is complete.
× ’ slower, more predictable anesthetic, such
as gas anesthetic, may be used to maintain
the anesthesia once the patient is in stage
3.
V Recovery Ȃ the period from discontinuation
of the anesthetic until the patient has
regained consciousness, movement and the
ability to communicate.
× uring recovery, the patient must be continuously
monitored to provide life support as needed and
to monitor for any adverse effects of the drugs
being used.
V arbiturate ’nesthetics Ȃ are
intravenous drugs used to induce rapid
anesthesia which is then maintained
with an inhaled drug.
× Thiopental (Penthotal) Ȃ most widely used
of the intravenous anesthetics.
× Methohexital ( revital)
V Nonbarbiturate ’nesthetics
× Midazolam (ersed)
× roperidol (½napsine)
× Etomidate (’midate)
× Ketamine (Ketalar)
× Propofol (iprivan)
V Ast tic Gass
× Oitr s xi ( l  cylir) Ȃ
akst f t  as ast tics a
t  last t xic.
× ycl
r
a ( ra cylir)
× t yl (r cylir)
V olatile iquids
× ½nhaled anesthetics are either gases or volatile liquids that
are unstable at room temperature and release gases.
× These gases are then inhaled by the patient so these
volatile liquids act like gas anesthetics.
× Halothane (Fluothane)
× esflurane (Suprane)
× Enflurane (Ethrane)
× ½soflurane
× Methoxyflurane (Penthrane)
× Sevofulrane (Ultane)
V Ôeneral ’nesthetics are indicated for
producing sedation, hypnosis,
anesthesia, amnesia and
unconsciousness to allow performance
of painful surgical procedures.
V Ԓ are lipid soluble
V rugs that cause a loss of sensation in limited areas
of the body.
V Used primarily to prevent the patient from feeling
pain for varying periods of time after they have been
administered in the PNS.
V ½n increasing concentrations, local anesthetics can
also cause loss of the following:
× Temperature
× Touch
× Proprioception
× Skeletal muscle tone
V ery powerful nerve blockers, and it is very
important that their effects be limited to a
particular area of the body.
V ocal anesthetics are either esters or
amides.
× The ESTERS are broken down immediately in the
plasma by enzymes known as plasma esterases.
× The ’M½ES are metabolized more slowly in the
liver and serum levels of these drugs can increase
and lead to toxicity.
V Topical ’dministration
× Topical anesthesia involves applying a
cream, lotion, ointment or drop of a local
anesthetic to traumatized skin to relieve
pain.
× ’reas involved: mucous membranes in the
eye, nose, throat, mouth, urethra, anus or
rectum to relieve pain or to anesthetize the
area to facilitate a medical procedure.
V ½nfiltration
× ½nfiltration anesthesia involves injecting the
anesthetic directly into the tissues to be
treated.
× This injection brings the anesthetic into
contact with the nerve endings in the area
and prevents them from transmitting nerve
impulses to the brain.
V Field lock
× Field block anesthesia involves injecting the
anesthetic all around the area that will be affected
by the operation.
× This is more intense than infiltration anesthesia
because the anesthetic agent comes in contact
with all the nerve endings surrounding the area.
× This type of block is often used for T

TH
EXTR’CT½
N.
V Nerve lock
× Nerve block anesthesia involves injecting
the anesthetic at some point along the
nerve or nerves that run to and from the
region in which the loss of pain sensation or
muscle paralysis is desired.
× ’ peripheral nerve block blocks the sensory
and motor aspects of a particular nerve for
relief of pain or for diagnostic purposes.
V Nerve lock
× ith a central nerve block, the anesthetic is
injected into the roots of the nerves in the spinal
cord.
× ½n epidural anesthesia, the drug is injected into
the space where the nerves emerge from the
spinal cord.
× ’ caudal block involves injection into the sacral
canal below the epidural area.
V ½ntravenous Regional ’nesthesia
× ½nvolves carefully draining all of the blood
from the patientǯs arm or leg, securing a
tourniquet to prevent the anesthetic from
entering the general circulation and then
injecting the anesthetic into the vein of the
arm or leg.
× This technique is used for very specific
surgical procedures.