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35 Cards in this Set
- Front
- Back
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CNS depressants - sedatives |
-drugs that have an inhibitory effect on the CNS to the degree that they reduce -nervousness -excitability -irritability |
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CNS depressants - hypnotics |
-cause sleep -much more potent effect on CNS than sedatives -a sedative can become a hypnotic if it is given in large enough doses - |
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CNS depressant - sedative-hypnotics |
-at low doses, calm the CNS without inducing sleep -at high doses, calm the CNS to the point of causing sleep Classified in 3 groups -barbiturates -benzodiazepines -miscellaneous drugs |
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Benzodiazepines classifications |
-sedative hypnotic -anxiolytic (medication that relieves anxiety) |
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Benzodiazepines - sedative hypnotic types |
long acting intermediate acting short acting
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Long acting benzodiazepines |
diazepam clonazepam |
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intermediate acting benzodiazepines |
alprazolam lorazepam temazepam |
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short acting benzodiazepines |
midazolam, triazolam |
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benzodiazepines: mechanism of action |
-depress CNS activity -affect hyprothalamic, thalamic, and limbic systems of the brain -benzodiazepine receptors (GABA) -gamma aminobutyric acid -does not suppress REM sleep as much as barbiturates do -does not increase metabolism of other drugs |
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Benzodiazepines: drug effects |
-calming effect on the CNS -useful in controlling agitation and anxiety -reduce excessive sensory stimulation, inducing sleep -induce skeletal muscle relaxation |
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benzodiazepines: indication |
sedation sleep induction skeletal muscle relaxation anxiety relief and related depression treatment of acute seizure disorders treatment of alcohol withdrawal agitation relief balanced anesthesia moderate/conscious sedation |
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Benzodiazepines: adverse effects (mild and frequent) |
headache drowsiness dizziness cognitive impairment vertigo lethargy fall hazard for elderly persons "hangover" effect/daytime sleepiness |
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Benzodiazepines: toxicity and overdose |
-somnolence (sleepiness, drowsiness) -confusion -coma -diminished reflexes -does not cause hypotension and respiratory depression unless taken with other CNS depressants |
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Benzodiazepines: Antidote |
flumazenil |
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benzodiazepines: interactions |
-azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics -grapefruit juice -olanzapine -rifampin |
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nonbenzodiazepine hypnotics |
-used to treat insomnia -share many characteristics of benzodiazepine |
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nonbenzodiazepine: medications |
zaleplon zolidem eszoplicone ramelteon - does not cause CNS depression, no potential for abuse, and no withdrawal signs and symptoms |
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Barbiturates |
-habit forming -low therapeutic index -only a few used today |
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Barbiturates: mechanism of action |
-site of action is the brainstem |
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barbiturates: drug effects |
-low doses have sedative effects -high doses have hypnotic effects and lower respiratory rates -also notorious enzyme inducers
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notorious enzyme inducers |
-stimulate liver enzymes that cause metabolism or breakdown of many drugs -result in shortened duration of action |
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Barbiturates: indications |
-sedatives -anticonvulsants -anesthesia for surgical procedures |
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Barbiturates: 4 categories |
-ultrashort acting anesthesia for short surgical procedures -short acting sedation and control of convulsive conditions -intermediate acting sedation and control of convulsive conditions -long acting sleep induction, epileptic seizure prophylaxis |
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barbiturates: adverse effects on cardio CNS respiratory |
-cardiovascular vasodilation, hypotension -CNS drowsiness, lethargy, vertigo -respiratory respiratory depression, cough
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barbiturates: adverse effects on GI hematologic other |
- GI nausea, vomiting, diarrhea, constipation -Hematologic agranulocytosis, thrombocytopenia -other hypersensitivity reactions, reduced REM sleep resulting in agitation and inability to deal with normal stress |
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Barbiturates: toxicity and overdose |
-overdose leads to respiratory depression and subsequent respiratory arrest -overdose produces CNS depression (sleep to coma and death) |
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Barbiturates: toxicity and overdose therapeutics |
-anesthesia induction -uncontrollable seizures "phenobarbital coma" |
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Barbiturates: treatment of drug overdose |
-symptomatic and supportive -maintain adequate airway -assisted ventilation/oxygen therapy -fluids -pressor support -activated charcoal
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barbiturates: drug interactions |
-additive effects alcohol, antihistamine, benzodiazepines, opiods, tranquilizers -inhibited metabolism MAOI's will prolong effects of barbiturates -increased metabolism reduces anticoagulant response, leading to possible clot formation |
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common barbiturates |
pentobarbital phenobarbital |
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muscle relaxants |
-act to relieve pain associated with skeletal muscle spasms -majority are centrally acting-CNS is the site of action -direct acting - act directly on skeletal muscle -closely resemble GABA |
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MR: adverse effects |
euphoria lightheadedness dizziness drowsiness fatigue muscle weakness |
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common muscle relaxants |
baclofen cyclobenzaprine dantrolene metaxalone tizanidine carisoprodol chlorzoxazone methocarbamol |
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nursing implications for CNS depressants |
-obtain baseline vital signs and I&O, including supine and erect BP's -assess for contraindications -give hypnotics 30-60 min before bedtime -avoid alcohol and other CNS depressants -rebound insomnia may occur a few nights after a 3-4 week regimen is discontinued |
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nursing implications on monitoring for therapeutic effects |
-increased ability to sleep at night -fewer awakenings -shorter sleep induction time -few adverse effects -improved sense of well being |
